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Deep Brain Stimulation for Treatment-Resistant OCD
Darin D. Dougherty, MD, and Benjamin D. Greenberg, MD, PhD
Most people with obsessive-compulsive disorder (OCD) eventually respond to treatment with medication, behavioral therapy, or both. But for the small minority that does not improve with conventional treatments, a relatively new option is deep brain stimulation, or DBS.
About Deep Brain Stimulation
Since the mid-1980s, DBS has been used to treat Parkinson’s disease and other movement disorders. Electrical stimulation of a specific brain region in patients with Parkinson’s or other movement disorders usually significantly decreases tremor and other disabling symptoms of the illness.
A neurosurgeon implants electrodes into a specific region of the brain and connect them by wires under the skin to pulse generators, which are implanted just below the collarbone. The battery-powered pulse generator, also called an implantable neurostimulator, contains a microchip that regulates the stimulation.
Using a handheld wand and small computer, a physician determines the amount of electrical stimulation to be delivered through the electrodes. These devices are similar to those used for people with cardiac pacemakers. The biggest difference is that in DBS the electrodes are in the brain instead of in the heart.
Treatment for OCD
People who are eligible for DBS usually have had little or no response to all currently available medications and behavioral treatments for OCD.
Researchers first tested DBS in the late-1990s, implanting electrodes in the brains of four patients with treatment-resistant OCD. The early results were promising, when three patients experienced benefit. Since then, larger-scale trials have been conducted, and the specific area in the brain has been identified as the ventral capsule/ventral striatum, or VC/VS.
Even though the procedure involves opening the skull, it does not require destroying any brain tissue. And it allows for a wider range of electrical charge amounts than does an ablative procedure, which is one that does require making holes in the brain. DBS is a very specialized procedure that should be performed by a neurosurgeon with appropriate expertise at an institution that has experience with this intervention.
After the electrodes have been implanted, the treatment for OCD begins. A physician determines the amount of electrical stimulation and monitors it over time. Also, a psychiatrist with expertise in DBS should be directly involved over the months and years following surgery.
In 2008, of 26 patients with treatment-resistant OCD, 61.5 percent responded to DBS. Based on these results, the U.S. Food and Drug Administration (FDA) approved DBS for treatment-resistant OCD in July 2009.
Future of DBS
It appears that DBS should continue indefinitely for long-term benefit. One interesting clinical observation so far is that after DBS, behavior therapy may become effective for a patient who was unable to improve with such treatment before surgery.
The field of neurosurgery for treatment-resistant OCD has advanced considerably in recent years, but more research is needed to improve DBS treatment, as well as to better understand which areas of the brain are affected and how. Currently the National Institutes of Health (NIH) funds four institutions to conduct further studies of DBS for OCD (see list below). These are exciting times for this new OCD treatment, but we still have much to learn.
Darin D. Dougherty, MD, is Associate Professor of Psychiatry at Massachusetts General Hospital and Harvard Medical School
Benjamin D. Greenberg, MD, PhD, is Associate Professor at Butler Hospital, Brown Medical School
Find out more
DBS Therapy for Treatment-Resistant OCD
Institutions
Butler Hospital, Brown University
Principal Investigator: Benjamin Greenberg, MD, PhD
Contact: Richard Marsland, 401-455-6211, rmarsland@butler.org
Massachusetts General Hospital
Principal Investigator: Darin D. Dougherty, MD
Contact: Lindsay Rauch, Research Coordinator, 617-726-9281, lrauch@partners.org
Cleveland Clinic Foundation
Principal Investigator: Donald A. Malone Jr., MD
Contact: Jenna Stump: 216-444-2673, stumpj@ccf.org
University of Florida
Principal Investigator: Herb Ward, MD
Contact: Nikki Ricciuti, 352-392-8316, nikkir@ufl.edu
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