Focus of the Report: The use of deep brain stimulation (DBS) for treatment of refractory obsessive-compulsive disorder (OCD).

Technology Description: DBS therapy uses mild electrical impulses to regulate electrical activity of neural circuits. Patients undergo surgery to implant a medical device, consisting of a thin wire with electrodes at the tip, into a target area in the brain. In OCD, patients have had electrodes targeting DBS in 1 or more regions of the brain, including the ALIC (anterior limbs of the internal capsules), BST (bed nucleus of the stria terminalis), CN (caudate nucleus), STN (subthalamic nucleus), or VC/VS (ventral capsule/ventral striatum). A neurostimulator device, or implantable pulse generator, is then placed under the skin of the patient’s collarbone. Programming of the neurostimulator is performed in an outpatient setting using patient feedback and objective measurements.

Controversy: DBS is an invasive option for treatment of OCD that is used only as a treatment of last resort. While evidence has recently progressed from mainly case series and cohort studies, the body of evidence employing crossover designs and/or sham controls is currently still limited in scope and sample size. DBS stimulation parameters such as probe placement, voltage, pulse width and frequency ranges vary widely across studies, creating uncertainty regarding the optimal conditions required to achieve maximum treatment benefit.

Key Questions:

  • Does DBS improve clinical outcomes in patients with treatment-refractory OCD?

  • How does DBS compare with alternative interventions for treatment-refractory OCD?

  • Are there any immediate or long-term safety complications associated with the use of DBS for treatment-refractory OCD?

  • Have definitive patient selection criteria been established for the use of DBS for OCD treatment?

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