Deep Brain Stimulation Promising New Treatment for Obsessive Compulsive Disorder

Obsessive Compulsive Disorder (OCD) is an anxiety disorder that causes a person to become trapped in a pattern of repetitive thoughts and behaviors, that are senseless and often times distressing. According to the National Institute of Mental Health, OCD affects 2-3 percent of the population, revealing that OCD is more common than some severe mental illnesses, including schizophrenia, biopolar disorder, or panic disorder. OCD affects people of all ethnic groups, and both males and females are equally affected. A new study, "Deep Brain Stimulation (DBS) for the Treatment of Obsessive Compulsive Disorder (OCD): Preliminary Results from a Multicenter Prospective Trial," highlights bilateral DBS as a treatment of refractory OCD.

The study will be presented on Tuesday, April 29, from 11:45 to Noon, during the 71st Annual Meeting of the American Association of Neurological Surgeons (AANS) in San Diego.

The study's authors include Ali R. Rezai, MD, The Cleveland Clinic Foundation; Gerhard Friehs, MD, Brown University; Bart Nuttin, MD, University of Leuven; Scott Rauch, MD, Massachusetts General Hospital; Donald Malone, MD, The Cleveland Clinic Foundation; Paul Cosyns, MD, University of Leuven; Steven Rasmussen, MD, Brown University; and Benjamin Greenberg, MD, Brown University.

An estimated 20 percent of patients with OCD are intractable, and 50 percent of these patients are severely ill. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, it can destroy a person's ability to function at work, at school or even at home.

The authors of the study wanted to test a new treatment option for people suffering from OCD. As part of the study, 15 severely disabled OCD patients refractory to prolonged medication and behavioral therapy were enrolled in the study from 1998-2002. There were a total of seven males and eight females. The average age of onset of OCD was 14 years old, with DBS implantation occurring at an average age of 36 years.

Patients exhibited symptoms that included checking/incompleteness, touching, contamination fears, perfectionism, pervasive rituals, arranging, washing, counting, fear of harming, and intrusive obsessions.

Patients were operated on at the University of Leuven, Belgium, Brown University/Rhode Island Hospital, and The Cleveland Clinic Foundation. The operations involved implantation of bilateral deep brain stimulators in the part of the brain known as the anterior limb of the internal capsule. The primary team of caregivers included psychiatrists, neuropsychologists, neurosurgeons, neurologists, neuroradiologists, neurophysiologists and ethicists. In addition, each of the medical centers involved in the study obtained approval from their Institutional Review Boards and an Independent Review Committee comprised of healthcare professionals.

Overall, patients reported an improved quality of life following DBS treatment, even though not all effects could be considered an improvement to their lives. Some effects of the DBS included mood elevation (although sometimes acute depression or a "sadness sensation"), hypomania (a mild mania), anxiety reduction, decreased OCD symptoms, increased alertness and energy, memory flashbacks, irritability, muscle contraction, epigastric (stomach) and olfactory (sense of smell) sensations, nausea, vomiting, visual changes (blurring), paresthesisas (facial) and tachycardia (abnormal heart rhythms).

"Deep brain stimulation has the advantage of being reversible and adjustable and is now routinely used for the treatment of refractory movement disorders," said Dr. Rezai. "This treatment holds promise for the ongoing treatment of intractable obsessive compulsive disorder."

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.