Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Correspondence
  • Published:

Comment to: Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?

Molecular Psychiatry volume 27, pages 1276–1277 (2022)Cite this article

Subjects

With great interest, we have read the perspective “Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?” by Wu et al. on behalf of the Task Force on Neurosurgery for Psychiatric Disorders of the World Society for Stereotactic and Functional Neurosurgery (WSSFN). The authors reviewed the current evidence for deep brain stimulation (DBS) for OCD, and conclude that it is an emerging but not established therapy [1]. Though we agree with their recommendation that more clinical trials are needed to more firmly establish efficacy, the interpretation of the level of evidence of the reviewed studies is questionable.

In 2014, the WSSFN published consensus guidelines stating that a therapy becomes “approved” (established) when “at least two blinded (if possible) randomized controlled clinical trials from two different groups of researchers are published, both showing an acceptable risk–benefit ratio, at least comparable with other existing therapies.” [2] Two such RCTs have become available for the same DBS target and were reviewed by Wu et al. The authors conclude that DBS for OCD is an emerging therapy, based on one randomized controlled trial (RCT) by Luyten et al. that they classified as level 1 evidence [3], and one RCT by Denys et al. that they classified as level 2 evidence [4], one large cohort study and one open prospective international multi-center study. The authors make the distinction between level 1 and 2 evidence for the RCTs based on the definition by Sackett [5], who defines level 1 evidence as “a “positive” trial that demonstrated a statistically significant benefit from experimental treatment” and level 2 as “a trial with an interesting positive trend that is not statistically significant”.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Forest plots from the meta-analyses illustrating the effect size of deep brain stimulation for obsessive-compulsive disorder.

References

  1. Wu H, Hariz M, Visser-Vandewalle V, Zrinzo L, Coenen VA, Sheth SA, et al. Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy? Mol Psychiatry. 2021;26:60–65.

    Article  Google Scholar 

  2. Nuttin B, Wu H, Mayberg H, Hariz M, Gabriels L, Galert T, et al. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry. 2014;85:1003–8.

    Article  Google Scholar 

  3. Luyten L, Hendrickx S, Raymaekers S, Gabriels L, Nuttin B. Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder. Mol Psychiatry. 2016;21:1272–80.

    Article  CAS  Google Scholar 

  4. Denys D, Mantione M, Figee M, van den Munckhof P, Koerselman F, Westenberg H, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010;67:1061–8.

    Article  Google Scholar 

  5. Sackett DL. Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest. 1989;95:2S–4S.

    Article  CAS  Google Scholar 

  6. Ackerman DL, Greenland S. Multivariate meta-analysis of controlled drug studies for obsessive-compulsive disorder. J Clin Psychopharmacol. 2002;22:309–17.

    Article  CAS  Google Scholar 

  7. Walter SD. Number needed to treat (NNT): estimation of a measure of clinical benefit. Stat Med. 2001;20:3947–62.

    Article  CAS  Google Scholar 

  8. Staudt MD, Pouratian N, Miller JP, Hamani C, Raviv N, McKhann GM, et al. Congress of neurological surgeons systematic review and evidence-based guidelines for deep brain stimulations for obsessive-compulsive disorder: update of the 2014 guidelines. Neurosurgery. 2021;88:710–2.

    Article  Google Scholar 

  9. Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008;359:2121–34.

    Article  CAS  Google Scholar 

  10. Balshem H, Helfand M, Schunemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64:401–6.

    Article  Google Scholar 

  11. Mosley PE, Windels F, Morris J, Coyne T, Marsh R, Giorni A, et al. A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder. Transl Psychiatry. 2021;11:190.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Guido van Wingen, Isidoor Bergfeld, Pelle de Koning, Ilse Graat, Judy Luigjes, Roel Mocking, Yasmin Namavar, Pieter Ooms, Geeske van Rooijen, Nienke Vulink & Damiaan Denys

  2. Department of Neurology & Neurosurgery, UMC Utrecht, Utrecht, The Netherlands

    Mariska Mantione

  3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Martijn Figee

Authors
  1. Guido van Wingen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Isidoor Bergfeld
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pelle de Koning
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ilse Graat
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Judy Luigjes
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Roel Mocking
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasmin Namavar
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pieter Ooms
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Geeske van Rooijen
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Mariska Mantione
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Martijn Figee
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Damiaan Denys
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: GvW, IB and DD; Formal analysis: IB; Writing—original draft: GvW; Writing—review & editing: IB, PdK, IG, JL, RM, YN, PO, GvR, NV, MM, MF, DD.

Corresponding author

Correspondence to Guido van Wingen.

Ethics declarations

Competing interests

DD has received in-kind research support from Medtronic and Boston Scientific.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van Wingen, G., Bergfeld, I., de Koning, P. et al. Comment to: Deep brain stimulation for refractory obsessive-compulsive disorder (OCD): emerging or established therapy?. Mol Psychiatry 27, 1276–1277 (2022). https://doi.org/10.1038/s41380-021-01411-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41380-021-01411-8

Search

Advanced search

Quick links