“Deep brain stimulation,” or DBS, may provide significant relief to as many as two-thirds of patients with severe obsessive-compulsive disorder, a new study finds. Photo by Raman Oza/Pixabay
When traditional treatments don’t help patients with severe obsessive-compulsive disorder (OCD), an implant that zaps the brain with electrical pulses could, a new study shows.
It found that the remedy — known as “deep brain stimulation,” or DBS — can provide significant relief to as many as two-thirds of such patients. On average, it can reduce symptoms caused by OCD by nearly half, the review found.
“[OCD involves] intrusive and bothersome thoughts that the individual cannot silence, and compulsions which are repetitive, ritualistic behaviors performed to reduce the anxiety caused by the compulsions,” said study author Dr. Sameer Sheth. He is an associate professor of neurosurgery at Baylor College of Medicine at Houston.
It is estimated that 3% of the world’s population is affected. For people with severe OCD that is out of control, the symptoms can be “devouring,” Sheth said. Examples of OCD include repeated hand washing, organizing and organizing, repeating and checking words in the head, and double-checking.
“They can prevent the person from being able to perform other necessary activities of life, and therefore be extremely disabling,” Sheth said. “Some people are unable to leave their room or house because of the cleaning rituals that would be necessary to re-enter, or can’t associate with others because of incessant taboo thoughts.”
The good news is that a combination of behavioral therapy and standard antidepressants — such as serotonin reuptake inhibitors (SRIs) — help many people.
The bad news: “About 10% to 20% don’t respond” to those treatments, Sheth said.
Enter DBS, a pacemaker-like system, for the brain.
“Like a pacemaker, it consists of a stimulator that is usually implanted under the skin in the upper chest and connected to a wire (electrode),” he said. “The electrode is implanted in specific regions in the brain,” including those involved in decision-making and the balancing of emotions.
The goal is that by restoring activity in these areas to a more balanced state, DBS will alleviate the symptoms of OCD.
But does it work?
To find out, Sheth’s team reviewed the findings of 31 studies conducted between 2005 and 2021.
Collectively, the studies included 345 adult OCD patients, with a mean age of 40 years. They had all struggled with severe to extreme OCD that had not responded to standard treatments.
On average, participants had battled crippling OCD symptoms for nearly 25 years. Many also suffered from depression, anxiety and/or personality disorders.
The review found that after an average treatment period of approximately two years, DBS had produced remarkable symptom improvements in two-thirds of patients. On average, symptoms decreased by 47%, the researchers reported.
Significant relief from depression was also attributed to DBS treatment. The studies found that it got rid of the problem in half of the patients for whom it was a problem.
The studies also found drawbacks to DBS therapy.
About one in five patients had at least one serious side effect of DBS, the review found. These can include an increased risk of seizures, suicide attempts, stroke, and new OCD symptoms associated with DBS itself.
Still, Sheth emphasized that the benefit is hard to ignore, noting that the level of symptom relief linked to DBS “usually allows people to function again,” at school, at work, and in relationships.
“Patients almost never get worse,” he added, “so there’s actually little risk of DBS for properly selected patients.”
Sheth’s takeaway: “DBS for OCD is an effective and safe treatment, as we have now demonstrated with an in-depth analysis of hundreds of patients in different countries.” Over time, DBS will likely become even more effective, as “the consistency of improvement will increase,” he added.
Two experts who were not involved in the study largely agree.
“Since the [DBS] electrodes are implanted in the areas of the brain that contribute to OCD, it’s no surprise that it works,” said Dr. Gopalkumar Rakesh, an assistant professor of psychiatry at the University of Kentucky College of Medicine, in Lexington.
What is needed now, Rakesh said, is the adoption of a “precision drug approach” to using DBS so that doctors and scientists can better predict what a person with OCD will respond to it.
dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York City, echoed that thought.
“While it’s not a brand new therapy, DBS is really in the development phase that needs more research,” Borenstein said. “So I’d say the results of this study point to the need for even more research, to determine which patients are more likely to benefit, and to really fine-tune that treatment to have the greatest benefit.”
The research review was published online Tuesday in the Journal of Neurology, Neurosurgery & Psychiatry.
There’s more about deep brain stimulation for OCD at Mount Sinai.
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