Deep Brain Stimulation and Ablative Neurosurgery for Obsessive Compulsive Disorder: a review

Deep Brain Stimulation e Neurocirurgia Ablativa para Transtorno Obsessivo Compulsivo: uma revisão

• Matheus dos Santos do Nascimento Carvalho (1)    
• Adriano Santana de Luna Costa (2)    
• Allan Vieira Almeida Santana (3)    
• Rodrigo Santana de Luna Batista (4)    
• Fernando Pinto de Mesquita Neto (5)    
• Rafael Ragazzi de Moraes (1)    
• José Maurício Meneses Dantas Bandeira (6)    
• Rebeca Montenegro de Lacerda (7)    
• Skarllet Cândida Silva dos Santos (8)    
• Euclides Maurício Trindade Filho (9)    
• Felipe Gomes de Barros Pontes (10)    
• Marcos Antonio Duarte Madeiro Filho (11)    

• https://doi.org/10.22290/jbnc.2023.340305
• J Bras Neurocirur 34 (3):311-320, 2023

Resumo

Introdução: O transtorno obsessivo-compulsivo (TOC) é caracterizado por pensamentos intrusivos de etiologia não esclarecida, que pode ser graduada através do escore Y-BOCS. Diante da refratariedade a medicamentos, modalidades de neurocirurgia funcional têm surgido como alternativa ao tratamento dessa condição, como o Deep Brain Stimulation (DBS). Objetivo: Analisar os benefícios do uso do DBS em pacientes com TOC e compará-los com neurocirurgias ablativas Métodos: Trata-se de uma revisão integrativa com busca na base de dados PubMed utilizando os descritores “Deep Brain Stimulation”, “Obsessive compulsive disorder”, “Case report”, “Psychosurgery”, “Stereotactic” junto ao operador booleano “AND”. Posteriormente, realizou-se análise estatística dos relatos de caso (t de Student), a fim de avaliar alterações estatisticamente significativas nos pacientes. Resultados: DBS com estimulação no núcleo accumbens foi o procedimento mais realizado, enquanto nas cirurgias ablativas, a capsulotomia prevaleceu. Ademais, tanto os pacientes submetidos a DBS (p<0.001) como cirurgia ablativa (p=0.012) apresentaram uma redução estatisticamente significativa na pontuação Y-BOCS, embora sem variação significativa quando comparados entre si. Conclusão: Diante do estudo, o DBS mostrou-se uma alternativa importante para tratar pacientes com TOC refratário, embora apresente seus riscos que merecem ser considerados antes de sua aplicação.

Palavras-chave

Transtorno obsessivo compulsivo; Deep Brain Stimulation; Neurocirurgia

Abstract

Introduction: Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts of unknown etiology, which can be graded using the Y-BOCS score. Before the drug refractoriness, functional neurosurgery modalities have emerged as an alternative to treat this condition, such as Deep Brain Stimulation (DBS). Objective: To analyze the benefits of using DBS in patients with OCD and compare them with ablative neurosurgeries. Methods: This is an integrative review with research in PubMed database using the descriptors “Deep Brain Stimulation”, “Obsessive compulsive disorder”, “Case report”, “Psychosurgery”, “Stereotactic” together with the Boolean operator “AND”. Subsequently, a statistical analysis of the case reports (Student’s t) was carried out in order to assess statistically significant changes in the patients. Results: DBS with nucleus accumbens stimulation was the most common procedure, meanwhile in ablative surgeries, capsulotomy prevailed. In addition, both patients undergoing DBS (p<0.001) and ablative surgery (p=0.012) showed a statistically significant reduction in the Y-score BOCS, although without significant variation when compared to each other. Conclusion: In view of the study, DBS proved to be an important alternative to treat patients with refractory OCD, although it presents its risks that deserve to be considered before its application.

Keywords

Obsessive-compulsive disorder; Deep Brain Stimulation; Neurosurgery

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1MS, Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil.

2MD, Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil.

3MD, Universidade Federal de Alagoas, Maceió, AL, Brasil.

4MD, Centro Universitário Tiradentes, Maceió, AL, Brasil.

5MD, Universidade de Brasília, Maceió, AL, Brasil.

6MS, Medical student, Centro Universitário CESMAC, Maceió, AL, Brasil.

7MS, Medical student, Centro Universitário Tiradentes, Maceió, AL, Brasil.

8MS, Medical student, Universidade Federal de Alagoas, Maceió, AL, Brasil.

9MD, PhD, Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, AL, Brasil.

10MD, PhD, Universidade Federal de São Paulo, Maceió, AL, Brasil.

11MD, Irmandade da Santa Casa de Misericórdia de São Paulo, Maceió, AL, Brasil.

 

Received June 5, 2023

Accepted July 21, 2023