Clinical factors not necessary exclusion criteria for deep brain stimulation in OCD

Clinical and demographic factors should not be used as exclusion criteria when considering deep brain stimulation of the ventral anterior limb of the internal capsule for patients with refractory obsessive-compulsive disorder.

Researchers reported these findings in an observational cohort study published in Journal of Clinical Psychiatry.

“Deep brain stimulation (DBS) is an effective treatment for refractory psychiatric disorders, particularly obsessive-compulsive disorder (OCD),” Ilse Graat, MD, of the department of psychiatry at the University of Amsterdam, the Netherlands, and colleagues wrote. “Nevertheless, DBS is invasive and comes with a small risk of post-surgical complications and (reversible) side effects, such as cognitive complaints like problems with concentration, planning, and memory and transient hypomanic symptoms. Moreover, DBS requires substantial investment from patients and clinicians, and up to 50% of patients do not profit substantially from DBS.”

According to the researchers, the ability to select probable responders before DBS according to baseline characteristics that predict outcome would allow more optimal allocation of treatment resources.

In the current study, Graat and colleagues aimed to investigate whether baseline demographic and disease characteristics correlated with a 1-year prospective course of OCD and depressive symptoms among 70 consecutive patients who received DBS of the ventral anterior limb of the internal capsule (vALIC-DBS) for OCD. Patients had OCD diagnoses based on DSM-IV or DSM-5 criteria and received treatment between April 2005 and October 2017. Researchers used Fisher exact tests and binary logistic regression to analyze baseline characteristics and symptom reduction, with the goal of determining the feasibility of predicting individual response. They defined individual response as a greater than 35% reduction in Yale-Brown Obsessive Compulsive Scale score and a 50% reduction in Hamilton Depression Rating Scale score.

Results showed insight into illness represented the only significant individual response predictor. It had a positive predictive value of 84.4% and a negative predictive value of 44%. Graat and colleagues reported an association between late-onset OCD and greater symptom reduction (beta = –0.29; 95% CI, 0.53 to 0.04), as well as an association between comorbid personality disorder and less symptom reduction over time (beta = 0.88; 95% CI, 0.29 to 1.47); however, they did not significantly predict vALIC-DBS response. Later age at onset, comorbid personality disorder and insight into illness correlated with clinical outcomes following vALIC-DBS; however, predictive values were too small to facilitate clinical patient selection.

“Future models, including larger numbers of OCD patients, might improve prediction of response to DBS and facilitate personalized treatment,” Graat and colleagues wrote. “Until then, however, clinicians should stop excluding patients with refractory OCD from vALIC-DBS based on baseline clinical characteristics.”