title: Deep brain stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis.
abstract: BACKGROUND
  Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive-compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power.
  
  
  METHODS
  We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs.
  
  
  RESULTS
  Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) -8.93, 95% confidence interval (CI) -13.35 to -5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes.
  
  
  CONCLUSIONS
  DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.
authors: The University of Queensland Rural Clinical School,QLD,Australia.
authors: S
authors: S
authors: Kisely
authors: The University of Queensland Rural Clinical School,QLD,Australia.
authors: K
authors: K
authors: Hall
authors: Metro South Health Service, Woolloongabba, QLD,Australia.
authors: D
authors: D
authors: Siskind
authors: Metro South Health Service, Woolloongabba, QLD,Australia.
authors: J
authors: J
authors: Frater
authors: Metro South Health Service, Woolloongabba, QLD,Australia.
authors: S
authors: S
authors: Olson
authors: Metro South Health Service, Woolloongabba, QLD,Australia.
authors: D
authors: D
authors: Crompton
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome