Deep brain stimulation for chronic, severe, treatment-resistant obsessive-compulsive disorder in adults

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 12 sources, which was discussed by the committee. The evidence included 2 randomised controlled trials (both of which are also included in at least 1 of the meta-analyses), 2 meta-analyses, 2 systematic reviews (most of the patients who had deep brain stimulation in these reviews are also included in the meta-analyses), 1 non-randomised comparative study, 4 case series and 1 case report. It is presented in table 2 in the interventional procedures overview. Other relevant literature is in the appendix of the overview.

The professional experts and the committee considered the key efficacy outcomes to be: improvement in obsessive-compulsive disorder (OCD) symptoms and quality of life.

The professional experts and the committee considered the key safety outcomes to be: intracranial bleeding, infection, damage to adjacent brain structures, seizures, suicidal ideation, mood changes including hypomania, and other psychiatric and cognitive effects.

Four commentaries from patients who had experience of this procedure were received, which were discussed by the committee.

The committee noted that many of the patients included in the studies had OCD for many years before having deep brain stimulation.

The committee was informed that there is a national network of clinicians with expertise in OCD, and experts from this group are consulted when people are referred for this procedure.

The committee was informed that this procedure might be an alternative to stereotactic ablative surgery.

The committee was informed that the safety profile of this procedure was similar to the safety profile of deep brain stimulation for other indications.

The committee was pleased to receive commentary from patients who had the procedure. These commentaries supported the use of the procedure.