WASHINGTON, D.C. — Some cases of obsessive-compulsive disorder (OCD) are so unresponsive to treatments that patients turn to brain surgery to help alleviate their symptoms. One surgery, deep brain stimulation (DBS), involves implanting a device that sends electrical impulses into the brain.
The latest results show that patients who initially benefit from the therapy sustain their improvement as long as the stimulation continues.
Patients that improve with deep brain stimulation can progress from having symptoms that are “very severe” to more moderate ones, researchers said. That can mean a reduction in repetitive behaviors, such as frequent hand-washing.
However, the researchers emphasized, the treatment is not a cure.
“What DBS really does is make you into an average OCD patient,” said Dr. Benjamin Greenberg, a psychiatrist at Brown University and at Butler Hospital in Providence, R.I.
The treatment can reduce the amount that patients are consumed by their compulsions, making them better able to function in society, Greenberg said.
“[It] gives patients many, many, many more hours a day to actually live a life,” Greenberg said today, here at the annual meeting of the American Association for the Advancement of Science.
Surgery for OCD
OCD is characterized by recurrent, intrusive thoughts and repetitive behaviors that patients feel compelled to carry out, the researchers said. Patients might perform these behaviors for hours, and many are unable to leave their homes.
About 50 patients in the United States have undergone deep brain stimulation for OCD since 2000. In 2009, the Food and Drug Administration approved the treatment for severe cases involving patients who had not responded to drugs or behavioral therapy. Patients must have tried other treatments for at least five years before they can qualify as candidates for the surgery.
Most patients first experience an improvement in their moods, such as a decrease in anxiety, Greenberg said. Changes in their OCD symptoms come later.
After the device is implanted, some patients benefit from behavior therapies that weren’t working for them before, such as therapies in which they are exposed to their fears, Greenberg said. This could be because patients are able to approach the task without the paralyzing anxiety they felt before, Greenberg said — or the stimulation could be making this type of learning easier, he said.
If the device is shut off — which can happen if its batteries are depleted — the OCD symptoms return, along with anxiety and depression present before the treatment. This is further proof that the stimulation has an impact, the researchers said.
Patients can experience side effects of deep brain stimulation, including infection and hemorrhage, Greenberg said.
Because of the risks involved, it’s critical that deep brain stimulation only be performed on those who meet the criteria for it. Only about 30 patients have received the therapy in the United States in the last two years, Greenberg said.
The researchers said they need more information to determine which patients respond best to the therapy, and how OCD patients that have the surgery should be managed. But current evidence shows that patients who perform their behaviors primarily to avoid harm, such as washing their hands to avoid contamination, may benefit more, Greenberg said.
Greenberg is now conducting a clinical trial studying deep brain stimulation in OCD patients. In contrast to earlier pilot studies, this study will include a control group of patients who receive the surgery, but in whom the stimulation device is not turned on for a portion of the study.
If patients show improvements after therapy, it’s still critical that they receive assistance to help them integrate back into society, said Michael Okun, of the University of Florida.
“It’s not enough to just fix the symptoms,” Okun said. “Even if you have changes that are significant, you must focus on reintegration,” he said.
Pass it on: Surgery could be an option for people with obsessive compulsive disorder when no other treatments seem to work, but surgery isn’t without risks.
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