Efficacy of deep brain stimulation for obsessive-compulsive disorder: umbrella review and updated meta-analysis

Introduction: Deep brain stimulation (DBS) has become an established therapy for otherwise treatment-refractory obsessive-compulsive disorder (OCD). Although several studies and meta-analyses have demonstrated its efficacy, the results thus far have not been analyzed with the novel tool of an umbrella review. Here, we aim to provide an umbrella review and an updated meta-analysis of all previously published data concerning the outcomes of DBS for OCD. Methods: In adherence to PRISMA guidelines, an umbrella review and meta-analysis was conducted, systematically searching PubMed, Medline, Embase, and Web of Science for meta-analyses on the treatment of OCD with DBS. Individual studies within the included meta-analyses, along with new studies, were meticulously reviewed, and duplications were removed. The results were collected and pooled to generate forest plots. The primary outcome was the relative change in Y-BOCS, HAM-A, HAM-D and Global Assessment of Functioning (GAF) scores at the last available follow-up after DBS. Results: This umbrella review encompassed seven meta-analyses evaluating the outcomes of DBS in patients with OCD published between 2014 and 2022. The current updated meta-analysis, including 29 studies, revealed significant overall improvement in OCD symptoms following DBS, as measured by Y-BOCS (mean difference (MD = 14.12 95 %CI = 12.43, 15.82, p < 0.00001, I² = 73 %), HAM-A (MD = 10.71, 95 %CI = 8.55, 12.88, p < 0.00001, I² = 63 %), HAM-D (MD = 11.14, 95 %CI = 9.39, 12.89, p < 0.00001, I² = 0 %), and GAF scales (MD = 5.20, 95 %CI = 4.51, 5.89, p < 0.00001, I² = 99 %). Conclusion: Our advanced analysis confirms that DBS is an effective therapy for OCD and its associated co-morbidities. Further research is essential to better understand and assess treatment efficacy and its underlying mechanisms.