Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Abstract

Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition. Traditionally, anterior capsulotomy (AC) was an established procedure for treatment of patients with refractory OCD. Over recent decades, deep brain stimulation (DBS) has gained popularity. In this paper the authors review the published literature and compare the outcome of AC and DBS targeting of the area of the ventral capsule/ventral striatum (VC/VS) and nucleus accumbens (NAcc). Patients in published cases were grouped according to whether they received AC or DBS and according to their preoperative scores on the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and then separated according to outcome measures: remission (YBOCS score < 8); response (≥ 35% improvement in YBOCS score); nonresponse (< 35% improvement in YBOCS score); and unfavorable (i.e., worsening of the baseline YBOCS score). Twenty studies were identified reporting on 170 patients; 62 patients underwent DBS of the VC/VS or the NAcc (mean age 38 years, follow-up 19 months, baseline YBOCS score of 33), and 108 patients underwent AC (mean age 36 years, follow-up 61 months, baseline YBOCS score of 30). In patients treated with DBS there was a 40% decrease in YBOCS score, compared with a 51% decrease for those who underwent AC (p = 0.004). Patients who underwent AC were 9% more likely to go into remission than patients treated with DBS (p = 0.02). No difference in complication rates was noted. Anterior capsulotomy is an efficient procedure for refractory OCD. Deep brain stimulation in the VC/VS and NAcc area is an emerging and promising therapy. The current popularity of DBS over ablative surgery for OCD is not due to nonefficacy of AC, but possibly because DBS is perceived as more acceptable by clinicians and patients.

Comparative effectiveness of neuroablation and deep brain stimulation for treatment-resistant obsessive-compulsive disorder: a meta-analytic study

“…A recent systematic review found comparable outcomes from both ABL and DBS for OCD 21. The purpose of this meta-analytic review is to provide a more definitive comparison of pooled ABL outcomes with regard to both safety and utility over time.…”

Neuroplasticity-targeted Intervention for Idiopathic Sudden Sensorineural Hearing Loss: A New Therapeutic Direction

“…Given that plasticity-promoting theory has been implicated in the alleviation of clinical disorders, several promising neuroplasticity-based interventions aimed at enhancing brain plasticity have been proposed. These include the principles of Hebbian learning [45], task-specific training [46], transcranial magnetic stimulation [47], deep brain stimulation [48], cognitive behavioral therapy [49], physical training [50], and neuropharmacotherapies that involve the molecular manipulation of cellular and synaptic pathways [27,51,52]. These interventions have been shown to promote clinical gains, improve behavioral outcomes, and increase brain plasticity.…”

Deep Brain Stimulation for the Treatment of Aggressive Behaviour: Considerations on Pathophysiology and Target Choice

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