Article type
Abstract
Background: Deep brain stimulation (DBS) has emerged as a potential treatment for refractory obsessive-compulsive disorder (OCD). However, the current evidence regarding its effectiveness and safety remains inconclusive.
Objectives: This Living Evidence Synthesis aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of DBS in severe and refractory OCD.
Methods: The Epistemonikos "Living Overview of Evidence (L.OVE)" platform was utilized for identification, screening, and study selection. Systematic reviews were used to generate an evidence matrix and as a source for study selection. This report includes randomized clinical trials assessing DBS use in severe and refractory OCD. Continuous tracking of published studies was conducted through daily searches and monthly screening. Data were extracted, and risk of bias was assessed using appropriate instruments. Outcome measures included severity, responder rate, quality of life, functioning, cognitive function, patient perceptions and adverse events. The GRADE approach was applied to assess the certainty of evidence.
Results: Searches retrieved 75 systematic reviews and 12 randomized clinical trials. Sixteen systematic reviews and 29 randomized clinical trials (17 identified through systematic reviews) were considered potentially eligible, with 11 cross-over randomized clinical trials being finally included. The selected trials included a total of 112 patients. Ten studies reported DBS outcomes on symptom severity, showing reductions compared to both sham stimulation and baseline. Responder rates ranged from 25% to 100%. Six studies showed no significant effects of DBS on cognitive function across various domains. One study found differences in quality of life only in vitality compared to sham stimulation. Another study reported improved functionality with active stimulation compared to sham. Regarding adverse events, 9 studies reported data, with a total of 58 severe adverse events associated with the DBS. GRADE quality of evidence for outcomes was low to very low.
Conclusions: the available scientific evidence is insufficient to establish the effectiveness and safety profile of DBS in severe and refractory OCD. Low-quality evidence suggests potential benefit, but the rate of adverse events is substantial. Larger, well-designed trials are needed to determine the effects of DBS use on outcomes in severe and refractory OCD.
Objectives: This Living Evidence Synthesis aims to provide a timely, rigorous, and continuously updated summary of the available evidence on the role of DBS in severe and refractory OCD.
Methods: The Epistemonikos "Living Overview of Evidence (L.OVE)" platform was utilized for identification, screening, and study selection. Systematic reviews were used to generate an evidence matrix and as a source for study selection. This report includes randomized clinical trials assessing DBS use in severe and refractory OCD. Continuous tracking of published studies was conducted through daily searches and monthly screening. Data were extracted, and risk of bias was assessed using appropriate instruments. Outcome measures included severity, responder rate, quality of life, functioning, cognitive function, patient perceptions and adverse events. The GRADE approach was applied to assess the certainty of evidence.
Results: Searches retrieved 75 systematic reviews and 12 randomized clinical trials. Sixteen systematic reviews and 29 randomized clinical trials (17 identified through systematic reviews) were considered potentially eligible, with 11 cross-over randomized clinical trials being finally included. The selected trials included a total of 112 patients. Ten studies reported DBS outcomes on symptom severity, showing reductions compared to both sham stimulation and baseline. Responder rates ranged from 25% to 100%. Six studies showed no significant effects of DBS on cognitive function across various domains. One study found differences in quality of life only in vitality compared to sham stimulation. Another study reported improved functionality with active stimulation compared to sham. Regarding adverse events, 9 studies reported data, with a total of 58 severe adverse events associated with the DBS. GRADE quality of evidence for outcomes was low to very low.
Conclusions: the available scientific evidence is insufficient to establish the effectiveness and safety profile of DBS in severe and refractory OCD. Low-quality evidence suggests potential benefit, but the rate of adverse events is substantial. Larger, well-designed trials are needed to determine the effects of DBS use on outcomes in severe and refractory OCD.