Deep Brain Stimulation for Treatment-Resistant OCD

Deep Brain Stimulation Is a Potential Pacemaker for the Brain

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Although a number of medications and psychological therapies are available to treat OCD, it has been estimated that between 25 and 40% of people will not respond adequately to these first-line strategies. If you are one of these individuals, you know that persistent and long-lasting OCD symptoms can lead to considerable suffering and upheaval in your personal and professional life.

In the last 20 years, the development of sophisticated brain imaging technologies such as functional magnetic resonance imaging (FMRI), has led to an explosive growth in our knowledge of the inner workings of the brain.

Results of these investigations have begun to explain the biological and anatomical basis of OCD. In particular, these studies have suggested that treatments targeting specific circuits in the brain could be helpful in reducing OCD symptoms in those people who have severe symptoms and do not respond to traditional treatment.

Deep brain stimulation may offer such a treatment.

Deep Brain Stimulation - A Primer

Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the implantation of removable electrodes. The way in which deep brain stimulation works is still unknown, but it has been suggested that it restores normal activity to areas of the brain that have become dysregulated.

Deep brain stimulation has shown considerable promise in the treatment of movement disorders such as Parkinson’s disease, and there is a growing body of evidence that it may be helpful for the treatment of OCD.

Deep brain stimulation has a number of advantages over traditional brain surgery for OCD.

  • Deep brain stimulation can be used to treat symptoms with little risk of permanent changes in the brain.
  • The level of stimulation can be adjusted up or down, and the stimulation can be used continuously or intermittently depending on the treatment plan. This allows for greater precision and tailoring of treatment.
  • The surgery is minimally invasive, meaning there is a reduced potential for side effects. It is important to keep in mind, however, that -- like any surgery -- there is a risk of complications or side effects, such as bleeding, infection or unanticipated changes in symptoms or personality. For this reason, deep brain stimulation is usually reserved for those people who have not responded to other forms of treatment.

Deep Brain Stimulation and OCD

Deep brain stimulation for the treatment of OCD has been evaluated in a handful of studies. However, because different techniques have been used and diverse brain areas targeted, it has been difficult to compare the results. These preliminary trials hold promise, but it's important to note that this is still an unapproved and experimental treatment for OCD.

Among the most exciting of these studies is an investigation that appeared in the New England Journal of Medicine. Over 10 months, half of the 18 treatment-resistant patients enrolled in the study first received a period of active stimulation of an area of the brain called the subthalamic nucleus, followed by a period of placebo stimulation.

The other half of the patients received the placebo stimulation, and then the real stimulation.

Following active stimulation, the majority of patients showed a reduction in OCD symptoms as well as an improvement in their overall ability to return to normal family life, engage in new relationships or go back to work. Only a very small number of patients achieved this while receiving the placebo stimulation.

Although this treatment did not work for everyone, the results of this study are a very positive development in the treatment of OCD. Future studies will have to further examine which brain areas to target as well as determine the pattern of stimulation that works best.

Sources:

Lipsman, N., Neimat, J., & Lozano, A.M. “Deep Brain Stimulation for Treatment-Refractory Obsessive-Compulsive Disorder: The Search for a Valid Target”. Neurosurgery 2007 61: 1-11.

Mallet L, Polosan M, Jaafari N, Baup N, Welter ML, Fontaine D, du Montcel ST, Yelnik J, Chéreau I, Arbus C, Raoul S, Aouizerate B, Damier P, Chabardès S, Czernecki V, Ardouin C, Krebs MO, Bardinet E, Chaynes P, Burbaud P, Cornu P, Derost P, Bougerol T, Bataille B, Mattei V, Dormont D, Devaux B, Vérin M, Houeto JL, Pollak P, Benabid AL, Agid Y, Krack P, Millet B, & Pelissolo A. “Subthalamic Nucleus Stimulation in Severe Obsessive-Compulsive Disorder”. The New England Journal of Medicine 2008 359: 2121-2134.

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