Treatment for Obsessive-compulsive Disorder (OCD) includes Cognitive Behavior Therapy, Exposure and Response Prevention and medications. However, despite these techniques, around 40%-60% of patients still experience symptoms.
In the 1990s, the first investigative study on the effectiveness of Deep Brain Stimulation (DBS) to treat OCD when medications do not work was conducted. Since it was started, other studies followed. And while there were successful treatments, there were also failed attempts.
Obsessive-compulsive Disorder
OCD is characterized by unwanted, repetitive and intrusive thoughts, images and ideas that a person who suffers from the disorder experience. These thoughts can have different sub-categories such as religious or scrupulosity, sexual, aggressive and harmful thoughts, among others. Consequently, the individual will have anxiety and feel uncomfortable. These intrusive thoughts or cognitive distortions, on the other hand, become obsessions and distress the person and the even the people he or she interacts with. To reduce the anxiety and the uncomfortable feeling, the OCD sufferer will resort to compulsions like repeatedly checking doors if these are locked, repeating numbers, names or phrases and manifesting maladaptive behaviors to lessen these obsessions. In recent years, DBS became the newest treatment to treat OCD.
What is Deep Brain Stimulation?
Deep Brain Stimulation is used to treat the symptoms of Parkinson’s disease and today, it is also a recommended treatment for OCD. DBS is a surgical procedure done to insert electrodes in certain parts of the brain to stimulate these areas. These removable electrodes are able to supply high frequency pulses which can result to the blocking of the specific part of the brain and at the same time mimics the effect on a person who suffers from a tissue lesion and results to the restoration of normal brain activity on the brain’s affected areas.
Benefits of Deep Brain Stimulation
- Deep brain stimulation does not destroy nerve cells or affect healthy tissue as opposed to tissue lesioning.
- It is reversible and the implanted electrodes are removable.
- It is possible for the clinician to adjust the levels of stimulation with the use of special computers.
Just like any surgical procedure, DBS poses health risks, especially with DBS is an invasive surgery to the brain. Experts are also concerned that the stimulation of the brain itself can lead to a number of negative side effects that include:
- Stroke
- Intra-cerebral hemorrhage
- Nausea
- Tonic-clonic seizure
- Difficulty in breathing
- Cardiovascular problems
- Anxiety
- Jaw muscle tightness
- Wound infection
- Insomnia
- Delirium
- Mood elevation/hypomania
- Disorders in movement
- Malfunction of device
- Stimulation-related gustatory and olfactory sensations
Patients with Parkinson’s disease who were treated with DBS were reported to experience negative effects; namely, mania, speech difficulty, movement problems, panic attacks and suicidal thoughts.
Possible Complications of the Device
- If the lead or connector moves and if there will be electrical or mechanical problems, readjustment is necessary.
- Pain and infection on the part where surgery was done.
- Allergic reaction.
- Damage on tissue resulting for programming parameters.
- Wearing of lead parts on the skin that can result to scarring or infection.
A review has been performed by a group of experts, the American Society of Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons. This was about the effectiveness of DBS on OCD patients. It was concluded that stimulating both sides of the brain, the sub-thalamic nucleus and the nucleus accumbens regions indeed does wonders to the client. In the conducted clinical trials, it was found out that 30% of the OCD symptoms were treated. On the other hand, there is no sufficient manifestation that the same result will occur on unilateral stimulation.
Humanitarian Device Exemption
There were only a limited number of participants that have joined the clinical trials on DBS and because of this, the approval of the Food and Drug Administration was only under “humanitarian device exemption” with guidelines on safe use and avoidance of overuse when it comes to the treatment of OCD.
Who are eligible to undergo DBS for treatment of OCD symptoms?
Patients who have severe symptoms and have been suffering for five years even with treatment with medications and behavioral therapy and who are between the ages of 18 and 65 years of age are the ones eligible for DBS treatment. Additionally, a psychiatrist or psychologist should be the one to conduct tests to measure the severity of the disorder while the patient should clearly understand the instructions and comply with them. He or she should also be in good health and in the sound mind to write an informed consent.
Who are not allowed to undergo Deep Brain Stimulation for OCD?
OCD sufferers who also have other medical or mental disorders cannot be candidates for DBS. These conditions are psychotic disorder, neurological disorder, bipolar disorder, body dysmorphic disorder and severe personality disorders. People who are also substance abusers and those who have suicidal tendencies and have a history of serious suicidal behavior are not eligible to get treated with Deep Brain Stimulation. Other reasons of ineligibility are abnormal MRI, inability to stick to the requirements of the clinical trial, inability to stop anti-coagulation therapy for surgery and pregnant or women of child-bearing age who is not using contraceptives.
What types of behavioral therapy should patients have taken before allowed to be treated with DBS?
For patients to be considered for OCD treatment via DBS, he or she should have undergone ERP for at least 20 times with an OCD expert. Additionally, he or she must have been under ERP for at least 12 weeks and CBT two times a week. As for medications, these should have been concurrent with the therapy sessions.
Medications Used in Treatment of OCD
A patient should have taken a combination of medications, such as, SSRIs (Selective Serotonin Reuptake Inhibitors) for a minimum of three months with the appropriate dosage, Clomipramine by itself or with SSRIs or a combination of SSRIs, anti-psychotic drugs and Clonazapam for at least two weeks for each combination.