Deep Brain Stimulation Effective for OCD, but Barriers Persist

Megan Brooks

September 27, 2022

Deep brain stimulation (DBS) is safe and effective for individuals with severe obsessive–compulsive disorder (OCD) that has been resistant to conventional therapy, a meta-analytic review confirms.

"DBS is a viable option for treatment-resistant OCD that can be expected to produce significant clinical benefit in about 2 out of 3 cases," study investigator Wayne Goodman, MD, chair, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, said in a statement.

However, "challenges in access still prevent many eligible individuals from getting this life-improving therapy," co-investigator Sameer Sheth, MD, PhD, vice chair of research, Department of Neurosurgery at Baylor, told Medscape Medical News.

The study was published online September 20 in the Journal of Neurology, Neurosurgery and Psychiatry.  

50% Reduction in Symptoms

The analysis included 34 studies conducted from 2005-2021, including nine randomized controlled trials (RCTs) and 25 non-RCTs, involving 352 patients with treatment-resistant OCD.

Both RCTs and non-RCTs had a predominantly low risk of bias.

The results show an average 14.3-point, or 47%, reduction (P < .01) in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores with DBS at last follow-up, with no significant difference between RCTs and non-RCTs.

Two thirds (66%) of patients fully responded to the DBS at last follow-up, the authors found.

DBS for treatment-resistant OCD also had a "strong" effect on comorbid depression, with 47% of patients considered "full responders" relative to their preoperative (baseline) depression status and an additional 16% considered partial responders (with a 30%–49% reduction in pre/post-treatment depressive symptoms).

"The demonstrated effects of DBS in this report are even more impressive when one considers that these patients have failed numerous behavioral and pharmacological therapies," said study investigator Eric Storch, PhD, professor and vice chair for the Department of Psychiatry and Behavioral Sciences at Baylor.

The rate of hardware-related complications was roughly 8% and infection rate was about 4% — in line with other data.

This study "offers hope for patients with severe symptoms of OCD whose disorder did not respond to a range of conventional therapies," Goodman said.

The Bigger Story

Sheth told Medscape Medical News the challenges in getting appropriate OCD patients access to DBS are multi-factorial.

"Psychiatrists and general practitioners and even patients are not aware of it, and insurance company policies are often out of date and ignorant of recent data such as those in this study," Sheth explained.

"Hopefully, improved awareness in the future will reverse these trends and lead to increased access for patients in need of this therapy," Sheth said.

Access to DBS for OCD is clearly the "bigger story" here, Brian Kopell, MD, who was not involved in the study, told Medscape Medical News.

This meta-analysis "confirms what all of us that do this with some regularity know — that DBS for OCD can be extremely helpful in patients who are refractory to standard OCD therapies," said Kopell, Department of Neurosurgery and director, Center for Neuromodulation, Mount Sinai Health System, New York City.

Yet, there is a dramatic difference in getting reimbursement for DBS in a case of dystonia vs OCD.

In the United States, DBS has humanitarian device exemption for use in both dystonia and OCD, Kopell noted.

"Yet because dystonia is a movement disorder, I can get DBS for dystonia paid for by most private insurance — no big deal," Kopell said.

"But OCD, because it's deemed a psychiatric disorder, is treated like the redheaded stepchild and it's monumentally hard to get insurance to pay for it — and if you can't pay for it, you can't do it. Simple as that," he added.

The study was supported by the McNair Foundation and the Dana Foundation. Storch is a consultant for Biohaven and owns stock in N V iew. Sheth is a consultant for Boston Scientific, NeuroPace, Abbott, and Zimmer Biomet. Kopell reports no relevant financial relationships.

J Neurol Neurosurg Psychiatry. Published online September 20, 2022. Full text

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