title: Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review.
abstract: BACKGROUND
  Obsessive-compulsive disorder is one of the most disabling of all psychiatric illnesses. Despite available pharmacological and psychotherapeutic treatments about 10% of patients remain severely affected and are considered treatment-refractory. For some of these patients deep brain stimulation offers an appropriate treatment method. The scope of this article is to review the published data and to compare different target structures and their effectiveness.
  
  
  METHODS
  PubMed search, last update June 2013, was conducted using the terms "deep brain stimulation" and "obsessive compulsive disorder".
  
  
  RESULTS
  In total 25 studies were found that reported five deep brain stimulation target structures to treat obsessive-compulsive disorder: the anterior limb of the internal capsule (five studies including 14 patients), nucleus accumbens (eight studies including 37 patients), ventral capsule/ventral striatum (four studies including 29 patients), subthalamic nucleus (five studies including 23 patients) and inferior thalamic peduncle (two studies including 6 patients). Despite the anatomical diversity, deep brain stimulation treatment results in similar response rates for the first four target structures. Inferior thalamic peduncle deep brain stimulation results in higher response rates but these results have to be interpreted with caution due to a very small number of cases. Procedure and device related adverse events are relatively low, as well as stimulation or therapy related side effects. Most stimulation related side effects are transient and decline after stimulation parameters have been changed.
  
  
  CONCLUSIONS
  Deep brain stimulation in treatment-refractory obsessive-compulsive disorder seems to be a relatively safe and promising treatment option. However, based on these studies no superior target structure could be identified. More research is needed to better understand mechanisms of action and response predictors that may help to develop a more personalized approach for these severely affected obsessive compulsive patients.
authors.forename: Sina
authors.initials: S
authors.lastname: Kohl
authors.forename: Deva M
authors.initials: DM
authors.lastname: Schönherr
authors.forename: Judy
authors.initials: J
authors.lastname: Luigjes
authors.forename: Damiaan
authors.initials: D
authors.lastname: Denys
authors.forename: Ulf J
authors.initials: UJ
authors.lastname: Mueller
authors.forename: Doris
authors.initials: D
authors.lastname: Lenartz
authors.forename: Veerle
authors.initials: V
authors.lastname: Visser-Vandewalle
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Kerpener Strasse 62, Cologne, 50937, Germany. jens.kuhn@uk-koeln.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
mesh_terms: D046690:Deep Brain Stimulation; D006801:Humans; D020772:Internal Capsule / Q000503:physiopathology; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*
references.citation: Adv Exp Med Biol. 1991;295:267-90
references.pmid: 1776572
references.citation: Neurosurgery. 2009 Dec;65(6 Suppl):203-9; discussion 209
references.pmid: 19934996
references.citation: Lancet. 1999 Feb 27;353(9154):724
references.pmid: 10073521
references.citation: Nat Neurosci. 2013 Apr;16(4):386-7
references.pmid: 23434914
references.citation: Psychiatry Res. 2012 Dec 30;200(2-3):1067-70
references.pmid: 22784468
references.citation: J Neurol. 2007 Jul;254(7):963-5
references.pmid: 17410328
references.citation: Acta Psychiatr Scand. 2003 Apr;107(4):275-82
references.pmid: 12662250
references.citation: JAMA Psychiatry. 2013 Jun;70(6):619-29
references.pmid: 23740050
references.citation: Neurosurgery. 2003 Jun;52(6):1263-72; discussion 1272-4
references.pmid: 12762871
references.citation: Ann N Y Acad Sci. 2013 Apr;1282:119-28
references.pmid: 23227826
references.citation: Tijdschr Psychiatr. 2013;55(3):203-8
references.pmid: 23512633
references.citation: Biol Psychiatry. 2014 Dec 15;76(12):963-9
references.pmid: 24832866
references.citation: Int J Neuropsychopharmacol. 2008 Dec;11(8):1181-3
references.pmid: 18700054
references.citation: World Neurosurg. 2013 Sep-Oct;80(3-4):S30.e17-25
references.pmid: 22824558
references.citation: PLoS Med. 2009 Jul 21;6(7):e1000097
references.pmid: 19621072
references.citation: Mol Psychiatry. 2010 Jan;15(1):64-79
references.pmid: 18490925
references.citation: Lancet. 1999 Oct 30;354(9189):1526
references.pmid: 10551504
references.citation: J Neurosurg. 2004 Jun;100(6):1084-6
references.pmid: 15200126
references.citation: J Neurosurg. 2003 May;98(5):1104-8
references.pmid: 12744372
references.citation: Neurobiol Dis. 2010 Jun;38(3):329-37
references.pmid: 19804831
references.citation: J Neuropsychiatry Clin Neurosci. 1989 Winter;1(1):27-36
references.pmid: 2535426
references.citation: Neurol Sci. 2010 Jun;31(3):353-9
references.pmid: 20127500
references.citation: Seishin Shinkeigaku Zasshi. 2013;115(9):975-80
references.pmid: 24228475
references.citation: CNS Spectr. 2005 Dec;10(12):966-79, 983
references.pmid: 16344833
references.citation: J Neuropsychiatry Clin Neurosci. 1994 Fall;6(4):467-77
references.pmid: 7841817
references.citation: J Neurol Neurosurg Psychiatry. 2007 Mar;78(3):310-4
references.pmid: 17012341
references.citation: Science. 1996 Nov 1;274(5288):740-3
references.pmid: 8966556
references.citation: J Neurol Neurosurg Psychiatry. 2007 Oct;78(10):1152-3
references.pmid: 17878197
references.citation: Psychiatr Clin North Am. 2006 Jun;29(2):553-84, xi
references.pmid: 16650723
references.citation: Arch Gen Psychiatry. 2010 Oct;67(10):1061-8
references.pmid: 20921122
references.citation: J Neurosci. 2009 Apr 22;29(16):5354-63
references.pmid: 19386932
references.citation: J Neurosurg. 2004 Oct;101(4):682-6
references.pmid: 15481726
references.citation: Neuron. 2005 Mar 3;45(5):651-60
references.pmid: 15748841
references.citation: Biol Psychiatry. 2010 Mar 15;67(6):535-42
references.pmid: 20116047
references.citation: Lancet. 2002 Oct 26;360(9342):1302-4
references.pmid: 12414208
references.citation: Biol Psychiatry. 2005 Mar 1;57(5):510-6
references.pmid: 15737666
references.citation: Dtsch Arztebl Int. 2010 Feb;107(7):105-13
references.pmid: 20221269
references.citation: Appl Neurophysiol. 1987;50(1-6):344-6
references.pmid: 3329873
references.citation: Neuroethics. 2013;6:499-511
references.pmid: 24273620
references.citation: Neuropsychiatr Dis Treat. 2009;5:183-7
references.pmid: 19557113
references.citation: Brain Stimul. 2012 Oct;5(4):599-604
references.pmid: 22305344
references.citation: Psychiatry Clin Neurosci. 2012 Jun;66(4):303-12
references.pmid: 22624735
references.citation: Neuropsychopharmacology. 2006 Nov;31(11):2384-93
references.pmid: 16855529
references.citation: Science. 2013 Jun 7;340(6137):1234-9
references.pmid: 23744948
references.citation: N Engl J Med. 2008 Nov 13;359(20):2121-34
references.pmid: 19005196
references.citation: Brain Stimul. 2013 Jan;6(1):96-8
references.pmid: 22405737
references.citation: Clin Neurol Neurosurg. 2010 Feb;112(2):137-43
references.pmid: 20006424
references.citation: Arch Gen Psychiatry. 1984 Oct;41(10):949-58
references.pmid: 6332590
references.citation: J Chem Neuroanat. 2003 Dec;26(4):293-9
references.pmid: 14729131
references.citation: Stereotact Funct Neurosurg. 2014;92(1):31-6
references.pmid: 24216976
references.citation: World Neurosurg. 2013 Sep-Oct;80(3-4):S31.e17-28
references.pmid: 22465369
references.citation: J Neuropsychiatry Clin Neurosci. 2014 Winter;26(1):81-6
references.pmid: 24515679
references.citation: World Neurosurg. 2013 Sep-Oct;80(3-4):S31.e1-8
references.pmid: 22469523