When is Deep Brain Stimulation for OCD an Appropriate Tx?
the MPR take:
A new evidence-based guideline from the Congress of Neurological Surgeons and the American Association of Neurological Surgeons outlines recommendations for the use of deep brain stimulation (DBS) in the treatment of obsessive-compulsive disorder (OCD). After reviewing 10 studies, the following recommendations were made:
- There is Level I evidence, based on a single class I study, for the use of bilateral subthalamic nucleus DBS for the treatment of medically refractory OCD.
- There is Level II evidence, based on a single class II study, for the use of bilateral nucleus accumbens DBS for the treatment of medically refractory OCD.
- There is insufficient evidence to make a recommendation for the use of unilateral DBS for the treatment of medically refractory OCD.
The timeframe for OCD improvement with DBS is unclear, with some studies suggesting an immediate effect with tremor control but a building effect for OCD. Currently DBS for the treatment of OCD in treatment-refractory patients is approved by the FDA under a humanitarian device exemption, but the authors note that it is more time-consuming to manage than DBS for movement disorders. DBS treatment for OCD requires approval from the local institutional review board and patient consent along with a treating psychiatrist to attest to the patient's suitability as a candidate.
BACKGROUND: It is estimated that 40% to 60% of patients with obsessive-compulsive disorder (OCD) continue to experience symptoms despite adequate medical management. For this population of treatment-refractory patients, promising results have been reported with the use of deep brain stimulation (DBS).
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