Evidence map›Paper›PMID 30853111›Full record

Trial reportBiological psychiatry2019

A Randomized Trial Directly Comparing Ventral Capsule and Anteromedial Subthalamic Nucleus Stimulation in Obsessive-Compulsive Disorder: Clinical and Imaging Evidence for Dissociable Effects.

Himanshu Tyagi, Annemieke M Apergis-Schoute, Harith Akram, Tom Foltynie, Patricia Limousin, Lynne M Drummond, Naomi A Fineberg, Keith Matthews, Marjan Jahanshahi, Trevor W Robbins and 4 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Biological psychiatry, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 106 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
106citing papers in PubMed, 7 pooled it
33.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

106 citing papers in PubMed, 7 syntheses or guidelines pooled it, 218 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  5. Invasive and Non-invasive Neurostimulation for OCD.Current topics in behavioral neurosciences · 2021
    Pooled it
  6. Cognitive Inflexibility in OCD and Related Disorders.Current topics in behavioral neurosciences · 2021
    Pooled it
  7. Pooled it
  8. Trial
  9. Trial
  10. Review
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  13. Article
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  18. A Multi-Symptom Circuit Architecture of Obsessive-Compulsive Disorder.medRxiv : the preprint server for health sciences · 2025
    Article
  19. Review
  20. Review

46 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

14 authors at 5 institutions in 1 country.

Himanshu TyagiDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Annemieke M Apergis-SchouteDepartment of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.
Harith AkramDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Tom FoltynieDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Patricia LimousinDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Lynne M DrummondHighly Specialised Service for OCD and BDD (England), SW London and St George's NHS Trust, London, United Kingdom.
Naomi A FinebergHighly Specialised Service for OCD and BDD (England), Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom; Centre for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.
Keith MatthewsDivision of Neuroscience, School of Medicine, University of Dundee, Dundee, United Kingdom; Advanced Interventions Service, NHS Tayside, Ninewells Hospital and Medical School, Dundee, United Kingdom.
Marjan JahanshahiDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom.
Trevor W RobbinsDepartment of Psychology, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.
Barbara J SahakianDepartment of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom.
Ludvic ZrinzoDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Marwan HarizDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Eileen M JoyceDepartment of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; The National Hospital for Neurology and Neurosurgery, London, United Kingdom. Electronic address: e.joyce@ucl.ac.uk.
National Hospital for Neurology and Neurosurgery · GBUniversity of Cambridge · GBSouth West London and St George's Mental Health NHS Trust · GBUniversity of Dundee · GBUniversity of Hertfordshire · GB

Funding

Medical Research Council MR/J012009/1Wellcome TrustWellcome Trust 104631/Z/14/Z
6 · The paper itself

Abstract

backgroundDeep brain stimulation (DBS) is an emerging treatment for severe obsessive-compulsive disorder (OCD). We compared the efficacy of ventral capsule/ventral striatal (VC/VS) and anteromedial subthalamic nucleus (amSTN) DBS in the same patients and tested for mechanistic differences on mood and cognitive flexibility and associated neural circuitry. The possible synergistic benefit of DBS at both sites and cognitive behavioral therapy was explored.

methodsSix patients with treatment-refractory OCD (5 men; Yale-Brown Obsessive Compulsive Scale score >32) entered double-blind counterbalanced phases of 12-week amSTN or VC/VS DBS, followed by 12-week open phases when amSTN and VC/VS were stimulated together, in which optimal stimulation parameters were achieved and adjunctive inpatient cognitive behavioral therapy was delivered. OCD and mood were assessed with standardized scales and cognitive flexibility with the Cambridge Neuropsychological Test Automated Battery Intra-Extra Dimensional Set-Shift task. Diffusion-weighted and intraoperative magnetic resonance imaging scans were performed for tractography from optimally activated electrode contacts.

resultsDBS at each site significantly and equivalently reduced OCD symptoms with little additional gain following combined stimulation. amSTN but not VC/VS DBS significantly improved cognitive flexibility, whereas VC/VS DBS had a greater effect on mood. The VC/VS effective site was within the VC. VC DBS connected primarily to the medial orbitofrontal cortex, and amSTN DBS to the lateral orbitofrontal cortex, dorsal anterior cingulate cortex, and dorsolateral prefrontal cortex. No further improvement followed cognitive behavioral therapy, reflecting a floor effect of DBS on OCD.

conclusionsBoth the VC/VS and amSTN are effective targets for severe treatment-refractory OCD. Differential improvements in mood and cognitive flexibility and their associated connectivity suggest that DBS at these sites modulates distinct brain networks.

Indexed as

Deep Brain StimulationAdultDouble-Blind MethodFemaleHumansMagnetic Resonance ImagingMaleMiddle AgedObsessive-Compulsive DisorderSubthalamic NucleusTreatment OutcomeVentral StriatumAnteromedial subthalamic nucleusDBSDeep brain stimulationObsessive-compulsive disorderOCDVentral internal capsule

Identifiers

PMID30853111
PMCPMC6467837
OpenAlexW2914312460

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.