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Estimulação cerebral profunda para perturbação obsessivo-compulsiva refratária : revisão sistemática e meta-análise
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Introdução: A eficácia e segurança da estimulação cerebral profunda (deep brain stimulation, DBS) na perturbação obsessivo-compulsiva (obsessive-compulsive disorder, OCD) foi relatada em vários estudos, mas a última revisão foi publicada em 2014, antes da publicação do maior estudo existente, e o seu efeito no humor nunca foi revisto. Objetivo: Avaliar a eficácia, o efeito sobre o humor e a segurança da DBS para a OCD. Métodos: Nos ensaios clínicos aleatorizados e em dupla ocultação (randomized controled trials, RCTs) foram determinadas as diferenças na Yale-Brown Obsessive Compulsive Scale (Y-BOCS) e numa ponderação de várias escalas de avaliação de depressão (escala ponderada de depressão, EPD) entre estimulação ativa e simulada. Em relatos e séries de casos (não-RCTs) foi determinada a melhoria entre os valores iniciais e finais na Y-BOCS e na EPD. Calcularam-se proporções de eventos adversos e desistências. Resultados e conclusões: Foram incluídos RCTs e não-RCTs. A DBS na OCD tem eficácia significativa na OCD, semelhante em locais de estimulação estriatais e não estriatais, bem como nos sintomas depressivos. Contudo, existe um número relevante de eventos adversos.
Introduction: The efficacy and safety of deep brain stimulation (DBS) in obsessive-compulsive disorder (OCD) were reported in serveral studies, but the last review was published in 2014, before the publication of the largest trial to date, and its effect on mood has never been reviwed. Objective: To evaluate efficacy, effect on mood and safety of DBS in OCD. Methods: In randomized controled trials (RCTs) differences in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and a padronization of several depression scales (escala ponderada de depressão, EPD) between active and sham stimulation were calculated. In case series and case reports (non-RCTs) the improvements in Y-BOCS and EPD from baseline were determined. Proportions of adverse events and drop-outs were calculated. Results and conclusions: RCTs e non-RCTs were included. There is a significant response to DBS in OCD symptoms, both in striatal and non-striatal targets, as well as in depressive symptoms. However, it has significant adverse events.
Introduction: The efficacy and safety of deep brain stimulation (DBS) in obsessive-compulsive disorder (OCD) were reported in serveral studies, but the last review was published in 2014, before the publication of the largest trial to date, and its effect on mood has never been reviwed. Objective: To evaluate efficacy, effect on mood and safety of DBS in OCD. Methods: In randomized controled trials (RCTs) differences in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and a padronization of several depression scales (escala ponderada de depressão, EPD) between active and sham stimulation were calculated. In case series and case reports (non-RCTs) the improvements in Y-BOCS and EPD from baseline were determined. Proportions of adverse events and drop-outs were calculated. Results and conclusions: RCTs e non-RCTs were included. There is a significant response to DBS in OCD symptoms, both in striatal and non-striatal targets, as well as in depressive symptoms. However, it has significant adverse events.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Perturbação obsessivo-compulsiva refratária Estimulação cerebral profunda Psiquiatria