Brain Stimulation Techniques in the Treatment of Obsessive-Compulsive Disorder: Current and Future Directions (original) (raw)
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Brain Stimulation in Obsessive-Compulsive Disorder (OCD): A Systematic Review
Current Neuropharmacology, 2019
Background: Obsessive-compulsive disorder (OCD) is a highly prevalent, severe, and chronic disease. There is a need for alternative strategies for treatment-resistant OCD. Objective: This review aims to assess the effect of brain stimulation techniques in OCD. Methods: We included papers published in peer-reviewed journals dealing with brain stimulation techniques in OCD. We conducted treatment-specific searches for OCD (Technique AND ((randomized OR randomised) AND control* AND trial) AND (magnetic AND stimulation OR (rTMS OR dTMS)) AND (obsess* OR compuls* OR OCD)) on six databases, i.e., PubMed, Cochrane, Scopus, CINAHL, PsycINFO, and Web of Science to identify randomised controlled trials and ClinicalTrials.gov for possible additional results. Results: Different add-on stimulation techniques could be effective for severely ill OCD patients unresponsive to drugs and/or behavioural therapy. Most evidence regarded deep brain stimulation (DBS) and transcranial magnetic stimulation (...
Obsessive-compulsive disorder: a critical review of therapeutic perspectives
Acta Psychiatrica Scandinavica, 2005
Objective: Obsessive-compulsive disorder (OCD) is a chronic disabling disease with profound implications for social functioning. Thirty per cent of all patients with OCD show insufficient improvement with state-of-the-art treatment. Conventional treatment and alternative treatment options for this population were investigated. Method: A selective review of the relevant scientific literature on OCD treatment and treatment resistance was conducted. Results: In addition to serotonin reuptake inhibitors (SRIs) and cognitive-behavioural therapy, alternative monotherapies, SRI augmentation strategies with a variety of drugs and electroconvulsive therapy have shown results in individual cases, but no conclusive evidence has been found in placebo-controlled trials. While studies investigating neurosurgery for refractory OCD show positive results, most of these studies have methodological shortcomings. Conclusion: Novel approaches currently under investigation that have shown promising effects for treatment-resistant OCD include SRI augmentation with atypical antipsychotics and chronic deep brain stimulation, a new surgical technique. Placebo-controlled trials for both treatment options will be needed to confirm preliminary findings.
Deep brain stimulation in obsessive-compulsive disorder
2009
Obsessive-compulsive disorder (OCD) is a psychiatric disorder that often runs a chronic, fluctuating course. A minority of patients do not improve by any available psychopharmacological and/or psychotherapeutic treatment. Treatment-refractory OCD patients considered for stereotactic neurosurgery have a longstanding history of persistent and extremely incapacitating intrusive obsessions and repetitive compulsions. This disorder creates tremendous suffering and a deep sense of shame, resulting in social isolation and often depression. Although a specific brain abnormality has not been identified, a growing number of brain imaging studies have accumulated evidence for a neurobiological basis for OCD. Eleven patients with severe, treatment refractory OCD were included in a double blind randomised crossover protocol. Electrical stimulation in the anterior limbs of the internal capsules and striatal gray matter inferiorly induced clinically significant therapeutic benefit in this patient group, not only in severity of OCD symptoms but also on the patient's mood scores. Technical aspects currently limit the use of capsular stimulation as a therapeutic option. This treatment option remains investigational for OCD patients and is not considered standard therapy.
Molecular Psychiatry
A consensus has yet to emerge whether deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) can be considered an established therapy. In 2014, the World Society for Stereotactic and Functional Neurosurgery (WSSFN) published consensus guidelines stating that a therapy becomes established when “at least two blinded randomized controlled clinical trials from two different groups of researchers are published, both reporting an acceptable risk-benefit ratio, at least comparable with other existing therapies. The clinical trials should be on the same brain area for the same psychiatric indication.” The authors have now compiled the available evidence to make a clear statement on whether DBS for OCD is established therapy. Two blinded randomized controlled trials have been published, one with level I evidence (Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score improved 37% during stimulation on), the other with level II evidence (25% improvement). A cl...
DEEP BRAIN STIMULATION FOR OBSESSIVE COMPULSIVE DISORDER: THE FIRST THREE AUSTRALIAN CASES
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.
2020
Introduction: Obsessive-Compulsive Disorder (OCD) belongs to the categories of psychiatric disorders with the potential to turn into a chronic condition without receiving the necessary treatments. The main feature of OCD is the frequent or intense obsession and compulsion that might induce great pain and suffering in patients. Moreover, as one of the most prevalent abnormalities, depression usually follows OCD. The present study aimed to compare the effects of Exposure and Response Prevention (ERP) and Transcranial Direct Current Stimulation (tDCS) treatments adjunct to pharmacotherapy on decreasing the severity of obsession-depression symptoms and improving the quality of life in OCD patients. Methods: This was a quasi-experimental study with a pre-test, post-test design and a follow-up stage. The statistical population comprised all the patients diagnosed with OCD in Zanjan Province, Iran. Besides, 26 OCD patients referring to Shahid Beheshti Medical Center in Zanjan were selected using a purposive sampling method. Then, they were randomly assigned to two treatment groups. The study subjects completed the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI 2), and the Quality of Life Questionnaire at the pre-treatment, posttreatment, and follow-up stages (1 month and 2 months after the treatment). Analysis of Covariance (ANCOVA) and Reliable Change Index (RCI) methods were used to measure statistical and clinical significances, respectively. The collected data were analyzed using SPSS. Results: The obtained data suggested no significant difference between the ERP and tDCS groups concerning the symptoms of OCD and depression at the post-test stage (P>0.05). Conversely, in terms of life quality, there was a significant difference between the ERP and tDCS groups at the post-test phase (P<0.05). Conclusion: Although the present findings revealed no statistically significant difference between the ERP and tDCS groups (except for the quality of life variable), the pharmacotherapy-ERP combination proved to be more effective than pharmaco therapy- tDCS in treating OCD patients.
BMC Research Notes, 2010
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.
Deep brain stimulation for refractory obsessive-compulsive disorder
Biological Psychiatry, 2005
Background: Neurosurgery (anterior capsulotomy) has been beneficial to many patients with debilitating, refractory obsessivecompulsive disorder (OCD), but the irreversibility of the procedure is an important limitation to its use. Nondestructive, electrical stimulation (deep brain stimulation; DBS) has proven an effective alternative to ablative surgery for neurological indications, suggesting potential utility in place of capsulotomy for OCD.
Deep brain stimulation for obsessive-compulsive disorders: long-term analysis of quality of life
Journal of Neurology, Neurosurgery & Psychiatry, 2014
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.