Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by persistent, unwanted thoughts (obsessions) and rituals used to mitigate those thoughts (compulsions). The disorder affects over 2 million Americans and 600,000 Californians. Although most people respond well to medication and/or behavioral therapy, roughly half of patients continue to experience symptoms despite receiving adequate care. How can doctors further minimize these symptoms? And how can they help patients who don’t respond to traditional treatments in the first place?
Deep brain stimulation is an invasive medical procedure that is primarily used to alleviate symptoms of Parkinson’s disease. Recently, however, deep brain stimulation has also been used to treat cases of depression, Tourette syndrome and – yes – OCD. Doctors use magnetic resonance imaging (MRI) or computed tomography (CT) to pinpoint an area of interest inside the brain before implanting an electrode. This electrode is connected to an implantable pulse generator, or IPS, located at the patient’s upper chest. The IPS sends out periodic bursts of electrical energy that presumably work to correct the faulty electricity in that area of the brain – “presumably” because the biological consequences of deep brain stimulation aren’t well understood. When it comes to OCD, doctors typically implant electrodes in areas that have been implicated in the disorder; this includes the anterior limb of the internal capsule, the inferior thalamic peduncle, the nucleus accumbens, the subthalamic nucleus and the ventral caudate.
Does it work?
A recent study published in the journal Neurosurgery conducted a systematic review of all the studies that used deep brain stimulation to treat OCD. Many studies use only a few patients, which makes it difficult to determine if the results are scientifically significant; for this reason, the researchers excluded all studies that had fewer than six patients. They also excluded studies that had a follow-up of less than six months in order to determine if deep brain stimulation can provide long-term rather than temporary relief. Even with these restrictions, the study found that deep brain stimulation reduced OCD symptoms when applied bilaterally to either the subthalamic nucleus or the nucleus accumbens. They were not able to find any evidence that deep brain stimulation helped when applied to other regions or on only one side of the brain.
Proceed with caution
It should be cautioned that treating OCD with deep brain stimulation is just one more therapeutic option – not a miracle. Although patients generally experience some relief from the treatment, their symptoms do not vanish entirely. Like with all mental health treatments, there are also some people who do not receive any benefits at all. In one study where researchers applied deep brain stimulation bilaterally to the subthalamic nucleus, one in four patients experienced no reduction in symptoms, and those that did only had their symptoms reduced from “severe” to “moderate.”
Given the invasive nature of deep brain stimulation, it would be better to know whether or not a patient would benefit from it before the surgery and – if so – how much. OCD can manifest in many different ways: some people are obsessed with cleanliness and contamination, whereas others are hoarders or checkers, to name a few examples. Perhaps only certain types of OCD can be treated with deep brain stimulation. When treating Parkinson’s disease, doctors have distinct guidelines that help them determine who is likely to benefit from deep brain stimulation. Alternatively, how well a patient responds to deep brain stimulation might have something to do with genetics. Whatever the answer happens to be, future research on how exactly deep brain stimulation affects the brain – and OCD – will be a tremendous asset.
Sovereign Health Group prides itself on following the development of cutting-edge techniques to treat both mental health disorders and substance abuse. It is for this reason that Sovereign Health is at the forefront for dual-diagnosis treatment. For further questions or to learn about our treatments for OCD, please call 866-554-5504 to speak to a member of our team.
Written by Courtney Lopresti, Sovereign Health Group Writer