Hamani and colleagues provide a systematic review of the literature and evidence based guidelines for deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD). Seven studies were identified for review that targeted various subcortical regions, including nucleus accumbens, ventral capsule/ventral striatum (which includes the nucleus accumbens), subthalamic nucleus, and inferior thalamic peduncle. Of these 7 studies, 3 randomized, controlled trials provide class I and II evidence supporting the superiority of active DBS over sham stimulation for controlling OCD symptoms (when defining a therapeutic response as a 25% improvement in YBOCS). The only trial providing class I evidence included 18 patients treated with subthalamic nucleus stimulation (2 mm anterior and 1 mm medial to the target used for Parkinson’s disease) with an average improvement of 32% in YBOCS. The two trials providing class II evidence both targeted nucleus accumbens. The authors acknowledge the need to further define the optimal target for DBS for OCD and biomarkers for identifying patients who may best respond to therapy. The authors express concern current safeguards in place for DBS for OCD may impede access to therapy and innovation in this domain.
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