Raman Oz/Pixabay“alt =””Deep brain stimulation,” or DBS, can provide significant relief for up to two-thirds of patients with severe obsessive-compulsive disorder, according to a new study. Photo by Raman Oz/Pixabay“/>
A new review of research shows that when traditional treatments don’t help patients with severe obsessive-compulsive disorder (OCD), an implant that destroys the brain with electrical impulses may just be there.
They found that a medication – known as “deep brain stimulation” or DBS – can provide significant relief for up to two-thirds of such patients. On average, it can reduce symptoms caused by OCD by almost half, as stated in the review.
“[OCD involves] intrusive and bothersome thoughts that a person cannot silence, and compulsions, which are repetitive, ritualistic behaviors performed to reduce anxiety caused by compulsions, ‘said study author Dr Sameer Sheth. He is a professor of neurosurgery at Baylor College of Medicine in Houston.
It is estimated that 3% of the world’s population is affected. For people with severe OCD that is uncontrolled, symptoms can be “overwhelming,” Sheth said. Examples of OCD include repeated hand washing, organizing and arranging, repeating words in your head, and checking and double checking.
“They can prevent a person from carrying out other vital activities and can therefore be extremely disabled,” Sheth said. “Some people cannot leave their room or home because of the cleaning rituals that would be necessary to re-enter, or they cannot interact with others because of constant thoughts of taboos.”
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% to 20% are unresponsive” to these therapies, Sheth said.
Enter DBS, a pacemaker-like system for the brain.
“Like a pacemaker, it consists of a pacemaker usually implanted under the skin in the upper part of the chest and connected to a wire (electrode),” he said. “The electrode is implanted in specific areas of the brain,” including those involved in making decisions and balancing emotions.
The goal is to bring activity in these areas back to a more balanced state, and DBS alleviates the symptoms of OCD.
But does it work?
To find out, Sheth’s team reviewed the results of 31 studies conducted between 2005 and 2021.
A total of 345 adult OCD patients with an average age of 40 participated in the studies. They all struggled with a severe or extreme form of OCD that did not respond to standard treatment.
On average, participants spent almost 25 years struggling with the paralyzing symptom of OCD. Many also suffered from depression, anxiety, and / or personality disorders.
The review found that after an average treatment period of about two years, DBS significantly improved symptoms in two-thirds of patients. Symptoms improved by an average of 47%, according to the researchers.
Significant depression relief has also been attributed to the treatment of DBS. Studies have shown that this eliminated the problem in half of the patients for whom it was a problem.
Studies have also shown disadvantages of DBS therapy.
As stated in the review, about one in five patients experienced at least one serious side effect of DBS. These can include an increased risk of seizures, suicide attempts, stroke, and new OCD symptoms related to DBS itself.
Even so, Sheth stressed that it was difficult to ignore this advantage, noting that the level of symptom relief associated with DBS “typically allows people to function again” at school, at work and in relationships.
“Patients almost never worsen,” he added, “so in reality the risk of DBS in well-matched patients is low.”
Sheth’s Take Out: “DBS for OCD is an effective and safe treatment method, as we have now shown by rigorously analyzing hundreds of patients in several countries.” DBS is likely to become even more effective over time as “consistency in improvement will increase,” he added.
The two experts who did not participate in the study largely agree.
“Because [DBS] the electrodes are implanted in the regions of the brain contributing to OCD, it is 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 to adopt a “precise medical approach” to the use of DBS so that doctors and scientists are better able to predict what makes a person with OCD respond well to it.
Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York, echoed that thought.
“While it’s not a completely new therapy, DBS really is at a more challenging stage of development,” said Borenstein. “So I would say that the results of this study point to the need for even more research to identify which patients would be more likely to benefit, and really fine-tune this treatment to get the most benefit.”
The research review was published online Tuesday in the Journal of Neurology, Neurosurgery & Psychiatry.
Learn more about Deep Brain Stimulation for OCD on Mount Sinai.
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