title: Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Meta-Analysis of Treatment Outcome and Predictors of Response.
abstract: BACKGROUND
  Deep brain stimulation (DBS) has been proposed as an alternative to ablative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targetting and stimulation conditions. We sought to determine the efficacy and tolerability of DBS in OCD and the existence of clinical predictors of response using meta-analysis.
  
  
  METHODS
  We searched the literature on DBS for OCD from 1999 through January 2014 using PubMed/MEDLINE and PsycINFO. We performed fixed and random-effect meta-analysis with score changes (pre-post DBS) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) as the primary-outcome measure, and the number of responders to treatment, quality of life and acceptability as secondary measures.
  
  
  RESULTS
  Thirty-one studies involving 116 subjects were identified. Eighty-three subjects were implanted in striatal areas--anterior limb of the internal capsule, ventral capsule and ventral striatum, nucleus accumbens and ventral caudate--27 in the subthalamic nucleus and six in the inferior thalamic peduncle. Global percentage of Y-BOCS reduction was estimated at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. No significant differences were detected in efficacy between targets. Five patients dropped out, but adverse effects were generally reported as mild, transient and reversible.
  
  
  CONCLUSIONS
  Our analysis confirms that DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. Well-controlled, randomized studies with larger samples are needed to establish the optimal targeting and stimulation conditions and to extend the analysis of clinical predictors of outcome.
authors.affiliation: OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain.
authors.forename: Pino
authors.initials: P
authors.lastname: Alonso
authors.affiliation: Methodological and Statistical Assessment Unit, Parc Sanitari Sant Joan de Déu-Fundació Sant Joan de Déu, Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cuadras
authors.affiliation: University Centre for OCD, Department of Psychiatry, UPC-KULeuven, Leuven, Belgium.
authors.forename: Loes
authors.initials: L
authors.lastname: Gabriëls
authors.affiliation: Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Brain Imaging Center, Academic Medical Center, University of Amsterdam, and the Netherlands Institute for Neuroscience, Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
authors.forename: Damiaan
authors.initials: D
authors.lastname: Denys
authors.affiliation: Department of Psychiatry and Behavioral Health System, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America.
authors.forename: Wayne
authors.initials: W
authors.lastname: Goodman
authors.affiliation: Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Butler Hospital, Providence, Rhode Island, United States of America.
authors.forename: Ben D
authors.initials: BD
authors.lastname: Greenberg
authors.affiliation: Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, General Hospital of Mexico, Mexico City, Mexico.
authors.forename: Fiacro
authors.initials: F
authors.lastname: Jimenez-Ponce
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Kuhn
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
authors.forename: Doris
authors.initials: D
authors.lastname: Lenartz
authors.affiliation: UPMC-Inserm U1127-CNRS UMR7225, ICM-Brain & Spine Institute, Paris, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Mallet
authors.affiliation: Department of Neurosurgery, UZ Leuven, KU Leuven, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Nuttin
authors.affiliation: OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Real
authors.affiliation: OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain.
authors.forename: Cinto
authors.initials: C
authors.lastname: Segalas
authors.affiliation: Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Rick
authors.initials: R
authors.lastname: Schuurman
authors.affiliation: UPMC Univ Paris 06, ER4, Modelling in Clinical Research, Paris, France; AP-HP, Hopitaux Universitaires Pitié-Salpétrière Charles-Foix, Department of Biostatistics and Medical Informatics, Paris, France.
authors.forename: Sophie Tezenas
authors.initials: ST
authors.lastname: du Montcel
authors.affiliation: OCD Clinical and Research Unit, Department of Psychiatry, Hospital de Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Menchon
mesh_terms: D000328:Adult; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome