RT Journal Article
SR Electronic
T1 Effectiveness and safety of neuroablation for severe and treatment-resistant obsessive–compulsive disorder: a systematic review and meta-analysis
JF Journal of Psychiatry and Neuroscience
JO J Psychiatry Neurosci
FD Canadian Medical Association
SP 356
OP 369
DO 10.1503/jpn.190079
VO 45
IS 5
A1 Yijie Lai
A1 Tao Wang
A1 Chencheng Zhang
A1 Guozhen Lin
A1 Valerie Voon
A1 Jinwoo Chang
A1 Bomin Sun
YR 2020
UL http://jpn.ca/content/45/5/356.abstract
AB Background: Several neuroablative procedures are available for severe and treatment-resistant obsessive–compulsive disorder (OCD), but limited knowledge about their relative clinical advantages and disadvantages poses obstacles for treatment decision-making.Methods: We searched PubMed, Embase, Scopus, Web of Knowledge and the Cochrane Library for reports up to February 2019. We reviewed the literature on the effectiveness (assessed using the Yale–Brown Obsessive Compulsive Scale [Y-BOCS]) and safety of various neuroablative interventions for severe and treatment-resistant OCD.Results: We included 23 studies involving 487 patients in the systematic review; 21 studies with 459 patients were included in the meta-analysis. Overall, neuroablation achieved a response rate (proportion of patients with ≥ 35% reduction in Y-BOCS) of 55%. Most of the adverse events (88.4%) were mild and transient. The top 3 adverse events were headache (14.9%), cognitive deficits (9.1%) and behaviour problems (8.1%). Severe or permanent adverse events included personality changes (2.3%) and brain edema or brain cyst (1.5%). The response rates associated with capsulotomy, limbic leucotomy and cingulotomy were 59% (95% confidence interval [CI] 54–65), 47% (95% CI 23–72) and 36% (95% CI 23–50), respectively. Interventions with different coverages of the dorsal part of the internal capsule were associated with different adverse-event profiles but were unlikely to modify clinical effectiveness.Limitations: The level of evidence of most included studies was relatively low.Conclusion: Ablative surgeries are safe and effective for a large proportion of patients with severe and treatment-resistant OCD. Among the available procedures, capsulotomy seemed to be the most effective. Further research is needed to improve clinical effectiveness and minimize risks.