title: Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons.
abstract: 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).
  
  
  OBJECTIVE
  To conduct a systematic review of the literature and develop evidence-based guidelines on DBS for OCD.
  
  
  METHODS
  A systematic literature search was undertaken using the PubMed database for articles published between 1966 and October 2012 combining the following words: "deep brain stimulation and obsessive-compulsive disorder" or "electrical stimulation and obsessive-compulsive disorder." Of 353 articles, 7 were retrieved for full-text review and analysis. The quality of the articles was assigned to each study and the strength of recommendation graded according to the guidelines development methodology of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Committee.
  
  
  RESULTS
  Of the 7 studies, 1 class I and 2 class II double-blind, randomized, controlled trials reported that bilateral DBS is more effective in improving OCD symptoms than sham treatment.
  
  
  CONCLUSIONS
  Based on the data published in the literature, the following recommendations can be made: (1) 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. (2) 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. (3) There is insufficient evidence to make a recommendation for the use of unilateral DBS for the treatment of medically refractory OCD.
authors: *Division of Neurosurgery, Toronto Western Hospital, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ‡Department of Neurosurgery and Center for Neuropharmacology and Neuroscience, Albany Medical College, Albany, New York; §Neuroscience Institute, Maine Medical Center, Portland, Maine; ¶Department of Neurosurgery, Northwestern University, Chicago, Illinois; ‖Departments of Neurosurgery, Neurology, Anesthesiology, and Biomedical Engineering, University of Michigan, Ann Arbor, Michigan; #Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois; **Department of Neurosurgery, University of Colorado, Denver, Colorado; ‡‡Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; §§Congress of Neurological Surgeons, Guidelines Department, Schaumburg, Illinois; ¶¶Department of Neurosurgery, Henry Ford Health System, Detroit, Michigan.
authors: Clement
authors: C
authors: Hamani
authors: Julie
authors: J
authors: Pilitsis
authors: Anand I
authors: AI
authors: Rughani
authors: Joshua M
authors: JM
authors: Rosenow
authors: Parag G
authors: PG
authors: Patil
authors: Konstantin S
authors: KS
authors: Slavin
authors: Aviva
authors: A
authors: Abosch
authors: Emad
authors: E
authors: Eskandar
authors: Laura S
authors: LS
authors: Mitchell
authors: Steven
authors: S
authors: Kalkanis
mesh_terms: D046690:Deep Brain Stimulation / Q000379:methods*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D014481:United States