Effectiveness of Deep Brain Stimulation for Treatment-Resistant OCD: Systematic Review of Anatomical Targets and Meta-Analysis of Randomized and Non-Randomized Studies.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials (alongside non-randomized studies)
PubMed 42651100 · doi:10.3390/brainsci16080789
What was done
Authors conducted a systematic review and meta-analysis across four databases through July 2025 evaluating deep brain stimulation (DBS) for severe treatment-resistant obsessive-compulsive disorder (TR-OCD). They analyzed 8 sham-controlled RCTs and 32 non-randomized pre/post studies separately across three follow-up intervals (≤12 months, >12 months, and last follow-up). Primary outcomes included Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores, comorbid anxiety and depression, and global functioning (GAF). Secondary analyses evaluated target-specific effects (recategorized by active contact stereotactic coordinates) and response predictors via meta-regression. Evidence certainty was graded using RoB 2, ROBINS-I, and GRADE.
What was found
In RCTs (n = 83), active DBS reduced Y-BOCS scores by 6.92 points (95% CI: 4.46 to 9.38; 18.3% reduction; p < 0.001; I² = 62.93%) versus sham. In non-randomized studies (n = 321), Y-BOCS score reductions were 13.83 points at ≤12 months, 17.34 points at >12 months, and 14.51 points (43.5% reduction; p < 0.001; I² ≥ 89.79%) at last follow-up. Across non-randomized cohorts, the pooled responder rate was 60.2% (95% CI: 52.8% to 67.2%) and the remission rate was 36.4% (95% CI: 29.8% to 43.5%). Significant improvements were also observed for anxiety (k = 7; d = 1.1; 95% CI: 0.72 to 1.56), depression (k = 24; d = 1.1; 95% CI: 0.80 to 1.26), and global functioning (k = 14; mean difference = 25.62 points; 95% CI: 22.18 to 29.03). Meta-regression identified longer follow-up duration as the sole significant predictor of Y-BOCS improvement (p = 0.042). Target-specific efficacy varied: the inferior thalamic peduncle showed the largest improvement (19.70-point reduction, based on 2 arms), nucleus accumbens stimulation did not reach the ≥35% clinical response threshold, and mediodorsal/ventral anterior thalamic targets showed no statistically significant benefit.
Why it matters
This review provides quantitative evidence that DBS delivers durable, multi-domain symptom relief in treatment-resistant OCD while demonstrating that therapeutic efficacy depends heavily on the specific anatomical brain target chosen.
Limits
The randomized evidence base is small (8 trials totaling only 83 participants). Non-randomized studies exhibited very high statistical heterogeneity (I² ≥ 89.79%). Findings for specific targets, such as the inferior thalamic peduncle, were limited to very few trial arms, and overall evidence certainty was downgraded to moderate for RCTs and low for non-randomized data.
Cited by
- supports Clinical OCD data shows that large therapeutic effects can be achieved by isolating and modifying a single brain circuit.