Mazzoleni Adele, Bhatia Shreya, Bantounou Maria A, Kumar Niraj S, Dzalto Monika, Soiza Roy L
Barts and the London School of Medicine and Dentistry, UK.
Queen's University Belfast, Northern Ireland.
BJPsych Open. 2023 Aug 8;9(5):e148. doi: 10.1192/bjo.2023.539.
Deep brain stimulation (DBS) has been proposed to improve symptoms of obsessive-compulsive disorder (OCD) but is not yet an established therapy.
To identify relevant guidelines and assess their recommendations for the use of DBS in OCD.
Medline, Embase, American Psychiatric Association PsycInfo and Scopus were searched, as were websites of relevant societies and guideline development organisations. The review was based on the PRISMA recommendations, and the search strategy was verified by a medical librarian. The protocol was developed and registered with PROSPERO (CRD42022353715). The guidelines were assessed for quality using the AGREE II instrument.
Nine guidelines were identified. Three guidelines scored >80% on AGREE II. 'Scope and Purpose' and 'Editorial Independence' were the highest scoring domains, but 'Applicability' scores were low. Eight guidelines recommended that DBS is used after all other treatment options have failed to alleviate OCD symptoms. One guideline did not recommend DBS beyond a research setting. Only one guideline performed a cost-effectiveness analysis; the other eight did not provide details on safe or effective DBS protocols.
Despite a very limited evidence base, eight of the nine identified guidelines supported the use of DBS for OCD as a last line of therapy; however, multiple aspects of DBS provision were not addressed.
深部脑刺激（DBS）已被提议用于改善强迫症（OCD）的症状，但尚未成为一种既定的治疗方法。
确定相关指南并评估其对DBS用于治疗OCD的建议。
检索了Medline、Embase、美国精神病学协会PsycInfo和Scopus数据库，以及相关学会和指南制定组织的网站。该综述基于PRISMA建议，检索策略由医学图书馆员进行了验证。研究方案已制定并在PROSPERO（CRD42022353715）上注册。使用AGREE II工具对指南的质量进行评估。
共识别出九条指南。三条指南在AGREE II上的得分超过80%。“范围和目的”以及“编辑独立性”是得分最高的领域，但“适用性”得分较低。八条指南建议在所有其他治疗方案均未能缓解OCD症状后使用DBS。一条指南不建议在研究环境之外使用DBS。只有一条指南进行了成本效益分析；其他八条未提供关于安全或有效的DBS方案的详细信息。
尽管证据基础非常有限，但九条已识别指南中的八条支持将DBS作为OCD的最后一线治疗方法；然而，DBS治疗的多个方面未得到解决。
