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Deep brain stimulation for obsessive-compulsive disorder:A systematic review of worldwide experience after 20 years

World Journal of Psychiatry 2021年第9期11卷 659-680页

作者： Lorea Mar-Barrutia Eva Real Cinto Segalas sara bertolin Jose Manuel Menchon Pino Alonso OCD Clinical and Research Unit Department of PsychiatryHospital de BellvitgeBarcelona 08907Spain Bellvitge Biomedical Research Institute-IDIBELL Barcelona 08907Spain CIBERSAM(Centro de Investigaci on en Red de Salud Mental) Carlos Ⅲ Health InstituteMadrid 28029Spain Department of Clinical Sciences Faculty of MedicineUniversity of BarcelonaBarcelona 08907Spain

BACKGROUND Twenty years after its first use in a patient with obsessive-compulsive disorder(OCD),the results confirm that deep brain stimulation(DBS)is a promising therapy for patients with severe and resistant forms of the disorder.Nevertheless,many unknowns remain,including the optimal anatomical targets,the best stimulation parameters,the long-term(LT)effects of the therapy,and the clinical or biological factors associated with response.This systematic review of the articles published to date on DBS for OCD assesses the short and LT efficacy of the therapy and seeks to identify predictors of response.AIM To summarize the existing knowledge on the efficacy and tolerability of DBS in treatment-resistant OCD.METHODS A comprehensive search was conducted in the PubMed,Cochrane,Scopus,and ClinicalTrials.gov databases from inception to December 31,2020,using the following strategy:“(Obsessive-compulsive disorder OR OCD)AND(deep brain stimulation OR DBS).”Clinical trials and observational studies published in English and evaluating the effectiveness of DBS for OCD in humans were included and screened for relevant information using a standardized collection tool.The inclusion criteria were as follows:a main diagnosis of OCD,DBS conducted for therapeutic purposes and variation in symptoms of OCD measured by the Yale-Brown Obsessive-Compulsive scale(Y-BOCS)as primary outcome.Data were analyzed with descriptive statistics.RESULTS Forty articles identified by the search strategy met the eligibility criteria.Applying a follow-up threshold of 36 mo,29 studies(with 230 patients)provided information on short-term(ST)response to DBS in,while 11(with 155 patients)reported results on LT response.Mean follow-up period was 18.5±8.0 mo for the ST studies and 63.7±20.7 mo for the LT studies.Overall,the percentage of reduction in Y-BOCS scores was similar in ST(47.4%)and LT responses(47.2%)to DBS,but more patients in the LT reports met the criteria for response(defined as a reduction in Y-BOCS scores>35%:ST,60.6%vs LT,70.7%).According

关键词： Deep brain stimulation Obsessive-compulsive disorder Predictors of response Side effects Short-term Long-term

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