Know all about deep brain stimulation, a new hope for OCD
It is estimated that 40% of obsessive compulsive disorder (OCD) sufferers do not respond adequately to standard treatments. Deep brain stimulation now seems to be an effective alternative
Obsessive compulsive disorder (OCD) is a relatively common illness where an individual tends to focus on a specific worry to a point that they cannot get rid of it; the worry tends to be intrusive in nature. OCD affects approximately 1 in 100 adults and can severely impact one's quality of life. Those who struggle with OCD often feel trapped by persistent thoughts and repetitive behaviours. These persistent worries can lead individuals to imagine potential negative outcomes for their loved ones. This may result in specific behaviors driven by the fear that something bad might occur… which could seem unusual to an observer.
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OCD can be mild, moderate or severe in nature and is marked by two primary symptoms: obsessions—unwelcome and repetitive thoughts; and compulsions—ritualistic behaviours aimed at reducing anxiety. Some people with OCD can have more than one type of obsession or compulsion.
In the last few decades, we've had several movies made on the theme of OCD, where the protagonist is shown as being “obsessed" with cleanliness, or order. In fact, OCD has many forms, other than the above two. OCD can interfere with the everyday function of a person’s life to the point where they are unable to participate in their familial, social, or professional duties. In very severe cases, the illness can make the person almost nonfunctional in their daily life. Patients can also contemplate or commit suicide.
TREATING OCD
Patients are first tried on medications known as SSRI – selective serotonin reuptake inhibitors such as fluoxetine, sertraline, escitalopram, fluvoxamine. Other options are tricyclic anti-depressants (TCAs) such as Clomipramine. There are several other medications that have been used and approved for the treatment of the illness. In addition, there are evidence-based therapies which work for OCD, such as cognitive behaviour therapy (CBT) for OCD. It is estimated that around 40% of OCD sufferers do not respond adequately to standard treatments. For those who continue to suffer despite these treatments, deep brain stimulation or DBS offers a potential alternative.
WHAT IS DEEP BRAIN STIMULATION?
Deep Brain Stimulation (DBS) is a surgical approach that involves placing tiny electrodes in specific areas of the brain. These electrodes deliver electrical impulses with the purpose of calming abnormal brain signals. Initially developed for conditions like Parkinson's disease, DBS is now being studied for its effects on various mental health disorders, including OCD.
Clinical studies reveal that DBS can provide significant symptom relief for individuals who have not improved with conventional therapies. In one clinical trial, nearly 60% of participants noted a meaningful decrease in OCD severity after undergoing DBS. Moreover, many of these patients experienced enhanced social engagement and daily functioning, suggesting that DBS improves not just symptoms but overall quality of life.
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The DBS procedure generally unfolds through the following key stages:
- Preoperative Assessment: This includes neuropsychological tests to evaluate if the patient is an appropriate candidate for the surgery.
- Surgery: Conducted under local anesthesia, surgeons implant electrodes in targeted brain regions and place a pulse generator beneath the skin, typically near the collarbone.
- Postoperative programming and follow-up: After surgery, settings on the pulse generator are regularly adjusted based on how the patient responds to the stimulation.
While the procedure is relatively safe, patients should be aware of potential risks like infection or bleeding. It is equally crucial to address the ethical aspects of DBS treatment. Patients should fully understand the risks, advantages, and uncertainties associated with DBS before proceeding.
BENEFITS OF DEEP BRAIN STIMULATION FOR OCD
- Reduction in severity of symptoms: Many patients report notable relief from compulsive behaviours and intrusive thoughts.
- Improved quality of life: Freed from the grip of their symptoms, patients can reconnect with loved ones, perform better at work, and engage in enjoyable activities again.
- New hope for treatment-resistant cases: For individuals who have tried multiple therapies without success, DBS may offer a unique and effective route for symptom management.
Though many patients enjoy significant benefits from DBS, with life changing benefits comes the risk of some side effects. Patients who undergo DBS may have mood swings that can range from irritability to depression, changes in cognitive abilities such as difficulty concentrating, and involuntary movements or twitches. Pre-surgical counselling and careful postoperative supervision is important to address these issues.
The landscape of DBS for OCD is still developing. Ongoing research seeks to optimize targeting techniques and understand the long-term implications of the procedure. Further advances in neurotechnology may enable more personalized treatment plans, with BrainSense technology enhancing the effectiveness of DBS not only for OCD but potentially for a range of other psychiatric conditions. As knowledge grows in this area, we are on the verge of making promising strides towards improving the lives of those battling OCD. Here's hoping.
The article was authored by Dr. Ajay Hegde, consultant - neuro-spine surgery, Manipal Hospital, Sarjapur Road and Dr. Sabina Rao, consultant - psychiatry, Manipal Hospital, Sarjapur Road.
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