While there are treatments available to deal with OCD symptoms, behaviors can still interfere with a person’s ability to function on a daily basis. Studies now show that when other treatment methods don’t work, deep brain stimulation (DBS) is an alternative that can make a difference. “OCD is a very severe disorder for some patients, and some patients do not respond to available treatments. Interventions such as DBS increase the options that are available for this difficult illness,” states Danesh Alam, MD, medical director of behavioral health at Northwestern Medicine Central DuPage Hospital. Here’s what you need to know before considering deep brain stimulation for treating OCD.
OCD and Treatment Options
While OCD symptoms can appear at any time, they typically start between the ages of 8 to 12, or in the late teens or early adult years. In addition to intrusive thoughts and anxious feelings, people with OCD can struggle with obsessive thoughts or compulsive, repetitive behaviors. Perfectionism obsession, relationship-related obsession, obsessive fear of contamination from germs or dirt, compulsive hand washing or cleaning, or mental compulsions are symptoms of the disorder. When any of those behaviors interfere with a person’s quality of life, or they can’t control the behaviors, the next step is to seek treatment. Both cognitive behavioral therapy and medication are commonly recognized ways to treat OCD. Exposure and response prevention therapy allows a person to have gradual exposure to the source of their obsession or compulsion while working not to have an OCD response. Selective serotonin reuptake inhibitors (SSRI), typically used as antidepressants, can help control OCD symptoms. When people use the appropriate therapy, medication, or a combination of both, OCD tendencies can be reduced by up to 60%. When those treatments don’t work, however, another option is available. “If they feel like the quality of life is really affected, and DBS can address those symptoms, then it becomes a reasonable option,” notes Jean-Philippe Langevin, MD, neurosurgeon and director of Restorative Neurosurgery and Deep Brain Stimulation Program, Pacific Neuroscience Institute at Providence Saint John’s Health Center.
Deep Brain Stimulation
It’s important for patients to understand what DBS is, and the expectations following surgery. “DBS basically is when an interventional neurosurgeon will put a couple of electrodes through the roof of the nose into the base of the brain,” Alam states. A small electrical stimulator, which can be planted in your chest or abdomen, helps to control the brain and regulate OCD symptoms. “You can explain it like a pacemaker for the brain. A cardiac pacemaker alters the activity of the heart. The DBS does the same thing but for the brain,” Langevin explains. Studies on the procedure for OCD have had varying results. A 2018 study showed that close to 50% of its patients experienced a reduction in OCD symptoms after the procedure. However, a 2019 study found that almost all of its participants had adverse reactions to the procedure, though over 50% were classified as mild. Almost 30% of those participants said their OCD worsened. In a more recent study, successfully treated patients (50%) showed a decrease in the severity of their anxiety as well as an improvement in cognitive function, and no significant cognitive decline was observed in any of the patients. The study samplings were small, and more research is needed. However, there is a lot for patients to consider. “It’s a big choice to undergo this surgery. It’s not something that you want to take lightly. But in the realm of what we do in neurosurgery, it’s one of the lower-risk surgeries,” says Langevin. Risks include bleeding in the brain, stroke, infection, or movement of the electrode from its implant location. In addition, slight paralysis, problems with speech or vision, or tingling in the face and limbs are all potential side effects of deep brain stimulation. With any medical procedure, there are pros and cons. There can also be barriers to getting the procedure, such as insurance not covering DBS, and being unable to access a doctor who is skilled at performing the surgery. But experts say for people who can’t leave their homes, who feel imprisoned by their symptoms, and who have tried everything else, it could offer the chance for a sense of normalcy. For some patients, it’s a risk they are willing to take to have a better quality of life. “Every patient has to consider the choice personally and decide if they’re okay with undergoing that surgery and running the risk,” Langevin concludes. “For some people it’s been transformative.”
