Deep Brain Stimulation for Obsessive-Compulsive Disorder
Deep Brain Stimulation Treatment for OCD and Other Conditions
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For many, the idea of brain surgery for the treatment of psychological issues evokes the fear of the failed psychosurgeries of the 1940s and '50s. We are a long way from those once-popular lobotomies in which the front of the brain was severely damaged to produce behavior changes. The development of sophisticated imaging technologies in the last few decades has made it possible to better understand the inner workings of our brains, and create more precise and less invasive treatment options. One of those treatments that we are starting to see success with in treating brain disorders is deep brain stimulation (DBS), which is nothing like the lobotomies of the past.
What Is Deep Brain Stimulation?
Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the surgical implantation of removable electrodes. The DBS control device is implanted near the abdomen or collarbone and connected to the brain with four electrodes. These electrodes emit signals that alter the functioning of the brain’s complex circuitry. Think of it as being like a cardiac pacemaker, except that it's for the brain. While we are still learning about the effects of DBS, in some cases it may activate sluggish circuits and in others slow overactive circuits. It has shown considerable promise in the treatment of movement disorders such as Parkinson’s disease; my colleagues at have seen some success with DBS as part of a treatment plan. There is growing evidence that deep brain stimulation can be used in the treatment of psychiatric conditions, particularly for obsessive-compulsive disorder (OCD).
Alleviating Symptoms of OCD
OCD is a chronic and debilitating illness that affects 2 to 4 percent of the U.S. population. It is an anxiety disorder in which individuals have repetitive compulsive behaviors or thoughts.
Last year, the FDA approved a deep-brain stimulation device as a treatment for severe OCD cases, which marked the first psychiatric indication for DBS. The treatment is for those who suffer the most severe OCD debilitation, and for whom no other treatment provides relief, such as patients who had previously failed to improve their condition using medication or behavioral cognitive therapy. With OCD, it is likely that the brain circuits are overactive and contributing to the heightened anxiety. The device blocks nerve signals that cause these symptoms. In a clinical trial of patients with severe obsessive-compulsive disorders, patients who had deep-brain stimulation therapy for a year showed an average 40 percent reduction in symptoms.
In addition to the potential reduction of OCD symptoms, some of the major benefits of deep brain stimulation over traditional brain surgery may include:
- Lower risk of permanent changes in the brain
- Adjustable stimulation levels to allow for greater precision and tailoring of treatment
Potential Medical Applications and Risks
While still an experimental treatment, deep brain stimulation shows promise for a wide range of brain disorders. Clinical trials are underway for epilepsy and depression. There are also experimental studies exploring the use of DBS for the treatment for obesity, traumatic brain injury, severe chronic pain, Alzheimer’s disease, anorexia, tinnitus (ringing in the ears), and addiction.
More than 40,000 people worldwide have undergone deep brain stimulation for a variety of disorders. While the initial studies have shown potential, it is not yet a cure and there are still serious risks to consider. At the end of the day, it is still brain surgery.
While we have a long way to go, what we have learned so far about deep-brain stimulation holds tremendous promise to treat obsessive-compulsive disorder and potentially a host of other disorders. It is an exciting time in brain science.
Mind your health,
For more information on Dr. Black, visit the Cedars-Sinai Department of Neurosurgery at .
Video: Deep Brain Stimulation Treatment for Epilepsy – Mayo Clinic
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