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Who Qualifies for Deep Brain Stimulation for OCD? Data From a Naturalistic Clinical Sample
Sarah L. Garnaat, Ph.D.; Benjamin D. Greenberg, M.D., Ph.D.; Nicholas J. Sibrava, Ph.D.; Wayne K. Goodman, M.D.; Maria C. Mancebo, Ph.D.; Jane L. Eisen, M.D.; Steven A. Rasmussen, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:81-86. doi:10.1176/appi.neuropsych.12090226
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From the Dept. of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI (SLG, BDG, NJS, MCM, JLE, SAR), Butler Hospital, Providence, RI (BDG, NJS, MCM, SAR), Brown Institute for Brain Science, Brown University, Providence, RI (BDG, SAR), Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI (BDG, SAR), Dept. of Psychiatry, Mt. Sinai Hospital, New York, NY (WKG).

Send correspondence to Sarah L. Garnaat, Ph.D.; E-mail: Sarah_Garnaat@brown.edu

Copyright © 2014 by the American Psychiatric Association

Received September 19, 2012; Revised February 01, 2013; Accepted February 25, 2013.

Abstract

A few patients with obsessive-compulsive disorder (OCD) remain severely impaired despite exhausting best-practice treatments. For them, neurosurgery (stereotactic ablation or deep brain stimulation) might be considered. The authors investigated the proportion of treatment-seeking OCD patients, in a naturalistic clinical sample, who met contemporary neurosurgery selection criteria. Using comprehensive baseline data on diagnosis, severity, and treatment history for adult patients from the NIMH-supported Brown Longitudinal OCD Study, only 2 of 325 patients met screening criteria for neurosurgery. This finding prompts consideration of new models for clinical trials with limited samples as well as methods of refining entry criteria for such invasive treatments.

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FIGURE 1. Breakdown of BLOCS (Brown Longitudinal Obsessive-Compulsive Study) Sample by Inclusion Criterion

ERP: exposure and response prevention.

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TABLE 1.Deep Brain Stimulation (DBS) for OCD Inclusion and Exclusion Criteria
Table Footer Note

Only criteria comparable to those used in this study are listed here. Full inclusion and exclusion criteria are available elsewhere.18

Table Footer Note

Controlled trial DBS criteria were replicated as closely as possible with available data in the present study. Whenever available data did not allow for perfect replication of the controlled trial criteria, we attempted to bias results toward subject inclusion so as not to underestimate the number of potential surgical candidates.

Table Footer Note

aIncluding olanzapine, risperidone, haloperidol, chlorpromazine, thiothixene, clozapine, quetiapine, ziprasidone, aripiprazole, and paliperidone.

Table Footer Note

bIncluding clonazepam, alprazolam, and lorazepam.

Table Footer Note

OCD: obsessive-compulsive disorder.

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