When traditional treatments fail to help patients with severe obsessive-compulsive disorder (OCD), an implant that zaps the brain with electrical impulses just might, according to a new research review.
He found that the remedy – known as “deep brain stimulation” or DBS – can offer significant relief to two-thirds of these patients. On average, it can reduce OCD-triggered symptoms by almost half, according to the review.
“[OCD involves] intrusive and bothersome 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 an associate professor of neurosurgery at Baylor College of Medicine in Houston.
It is estimated that 3% of the world’s population would be affected. For those with severe OCD that’s not controlled, the symptoms can be “all-consuming,” Sheth said. Examples of OCD include repeated hand washing, order and organization, repeating words in one’s head, checking, and double checking.
“They can prevent the person from being able to perform other activities necessary for life, and therefore be extremely disabling,” Sheth said. “Some people can’t leave their room or house because of the cleaning rituals that would be needed to get back in, or can’t interact with others because of constant 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% to 20% don’t respond” to these treatments, 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 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 emotional balancing.
The goal is that by restoring activity in these areas to a more balanced state, DBS will regulate the symptoms of OCD.
But does it work?
To find out, Sheth’s team looked at the results 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 battled a severe to extreme form of OCD that had failed to respond to standard treatments.
On average, the participants had spent nearly 25 years battling the debilitating symptoms of OCD. Many also suffered from depression, anxiety and/or personality disorders.
The review showed that after an average treatment period of about two years, DBS resulted in a noticeable improvement in symptoms in two-thirds of patients. On average, symptoms improved by 47%, the researchers reported.
Significant depression relief has also been attributed to DBS treatment. Studies found that it eliminated the problem in half of patients for whom it had been a concern.
Studies have also revealed downsides to DBS therapy.
About one in five patients experienced at least one serious side effect from DBS, according to the review. These may include an increased risk of seizures, suicide attempts, stroke, and new OCD symptoms related to DBS itself.
Still, Sheth stressed that the benefit is hard to ignore, noting that the level of symptom relief associated with DBS “usually gets people functioning again,” at school, work and in relationships.
“Patients almost never get worse,” he added, “so there’s actually little risk of DBS for appropriately selected patients.”
Sheth’s takeaway: “DBS for OCD is an effective and safe treatment, as we have now shown with rigorous analysis of hundreds of patients in multiple countries.” Over time, DBS is likely to become even more effective, as “consistency in improvement will increase,” he added.
Two experts who were not involved in the study largely agree.
” Since [DBS] If electrodes are implanted in brain regions contributing to OCD, it’s no surprise that it works,” said Dr. Gopalkumar Rakesh, assistant professor of psychiatry at the University of Kentucky College of Medicine, 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 are better able to predict what is doing. that a person with OCD responds well to it.
Dr. Jeffrey Borenstein, president and CEO of the Brain & Behavior Research Foundation in New York, echoed that thought.
“Even though it’s not a brand new therapy, DBS is really at the most research-needed stage of development,” Borenstein said. “So I would say that the results of this study underscore the need for even more research, to determine which patients would be most likely to benefit, and to really refine this treatment to achieve the greatest benefit. “
The research review was published online Tuesday in the Journal of Neurology, Neurosurgery & Psychiatry.
There is more on deep brain stimulation for OCD at Mount Sinai.
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