Raman Oza/Pixabay“alt=””deep brain stimulation,” or DBS, can provide significant relief for up to two-thirds of patients with severe obsessive-compulsive disorder, a new study has found. Photo of Raman Oza/Pixabay“/>
When traditional treatments fail to help patients with severe obsessive-compulsive disorder (OCD), an implant that destroys the brain with electrical pulses may, a new research review shows.
He found that the remedy, known as “deep brain stimulation” or DBS, can provide significant relief to two-thirds of these patients. On average, it can cut symptoms caused by OCD by almost half, according to the review.
“[OCD involves] intrusive and disturbing thoughts that the individual cannot silence, and compulsions which are repetitive ritual behaviors performed to reduce the anxiety produced by the compulsions,” said study author Dr. Sameer Sheth. He is a professor neurosurgery associate at Baylor College of Medicine in Houston.
It is estimated that 3% of the world’s population is affected. For those with severe, uncontrolled OCD, the symptoms can be “totalizing,” Sheth said. Examples of OCD include repetitive hand washing, tidying up, repeating words in the head, and checking and revising.
“They can prevent the person from being able to perform other necessary life activities and therefore be extremely disabling,” Sheth said. “Some people can’t leave their room or house because of the cleansing rituals that would be required to re-enter, or they can’t interact 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), helps many people.
The bad news: “About 10 percent to 20 percent don’t respond” to these treatments, Sheth said.
Enter DBS, a pacemaker-like system for the brain.
“Like a pacemaker, it consists of a stimulator usually implanted under the skin in the upper chest and connected to a lead (electrode),” he said. “The electrode is implanted in specific regions of the brain,” including those involved in decision-making and balancing emotions.
The goal is that by restoring activity in these areas to a more balanced state, DBS will resolve OCD symptoms.
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 patients with OCD, with an average age of 40 years. All had struggled with a severe to extreme form of OCD that had not responded to standard treatments.
On average, participants had spent nearly 25 years struggling with crippling OCD symptoms. Many also suffered from depression, anxiety and/or personality disorders.
The review showed that after an average treatment period of about two years, DBS had produced marked improvements in symptoms in two-thirds of patients. On average, symptoms decreased by 47 percent, the researchers reported.
Significant alleviation of depression was also attributed to DBS treatment. Studies found that it eliminated the problem in half of the patients for whom it had been a concern.
Studies also found disadvantages of DBS therapy.
About one in five patients experienced at least one serious side effect of DBS, the review found. These may include an increased risk of seizures, suicide attempts, stroke, and new OCD symptoms related to DBS itself.
Still, Sheth stressed that the upside is hard to ignore, noting that the level of symptom relief associated with DBS “generally allows people to function again,” at school, at work and relationships.
“Patients almost never get worse,” he added, “so there is little risk of DBS for appropriately selected patients.”
Sheth explains: “DBS for OCD is an effective and safe treatment, as we have now demonstrated through rigorous analysis of hundreds of patients in several countries.” Over time, DBS is likely to be even more effective as it will “increase consistency in improvement,” he added.
Two experts who were not involved in the study strongly agree.
“From [DBS] The electrodes are implanted in the regions of the brain that contribute to OCD, so it’s no surprise that it works,” said Dr. Gopalkumar Rakesh, 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 medicine approach” to the use of DBS, so that doctors and scientists can better predict what makes a person with OCD responds well to it.
Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York City, echoed that thought.
“Although not a brand new therapy, DBS is really at the most research-intensive stage of development,” Borenstein said. “So I would say that the results of this study point to the need for further research, to determine which patients would be most likely to benefit and to really adjust this treatment for the greatest benefit.”
The research review was published online Tuesday in the Journal of Neurology, Neurosurgery & Psychiatry.
More information on deep brain stimulation for OCD is available at Mount Sinai.
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