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DEEP bRAIN stimulation to Treat OCD

OCD is a very intrusive condition that affects a person's daily life. New research is showing that deep brain stimulation is an effective way to treat it.

What is Deep Brain Stimulation (DBS)?

Deep brain stimulation, or DBS, is a type of treatment that focuses on implanting electrodes throughout certain areas of one’s brain.1 The electrodes are used to produce impulses that will regulate abnormal ones. DBS is controlled by a device like a pacemaker. Doctors will insert a wire from your upper chest up to the electrodes in the brain to create the electrical impulses.

History of Deep Brain Stimulation

DBS can be linked back to 1870 when two German researchers used it on dogs. Soon, they were able to replicate their study with humans. Throughout the decades, researchers slowly continued testing different devices to cause electric stimulation.2

Deep brain stimulation finally gained ground when it was first approved by the FDA to help treat Parkinson’s Disease. It has been used to treat over 40,000 people with Parkinson’s between its adoption in 2002 up to the year 2013, and it helps treat other disorders as well.3

What is DBS Used to Treat?

DBS is used to treat several different conditions, including:

  • Obsessive-Compulsive Disorder (OCD)
  • Epilepsy
  • Dystonia
  • Essential Tremors
  • Parkinson’s Disease

What Are the Benefits of Deep Brain Stimulation?

There are several benefits of deep brain stimulation. The surgery is adaptable depending on the symptoms that a patient is experiencing. For some people, the electrodes only need to be implanted on one side of the brain. However, medical professionals have the ability to do implant on both sides of the brain.4

Secondly, all effects of deep brain stimulation can be reversed. Doctors are able to customize a plan for each patient to ensure that the procedure and treatment are as effective as possible. Medical professionals can also modify settings to get rid of potential side effects for each individual.

In addition, the device that controls the electrodes runs 24/7. This constant access means it can help manage symptoms all the time, even when a person is sleeping. Finally, DBS works well with other therapies, so patients are not limited to one type of treatment for whatever disorder they may be struggling with.5

Does DBS Work?

So far, doctors have seen outstanding results with deep brain stimulation. Most of the research has focused on how it stops tremors for people suffering from Parkinson’s Disease. However, it has also had amazing results for people struggling with other conditions, such as OCD.

Statistics on Deep Brain Stimulation

One study that concluded in 2020 showed that DBS resulted in an OCD remission rate.6 Normally, patients were able to reach remission by 36 months. However, there still needs to be more research on this rather new procedure. Only 4 of the 9 patients maintained some type of sustained response/OCD remission. Overall, DBS is an effective treatment, but there is still a lot of unknowns surrounding it.

Is It Safe?

Deep brain stimulation is a safe form of treatment. The surgery needed is only slightly invasive, and most medical professionals consider it safe. However, all surgeries have risks and possibilities of complications. Side effects may occur for procedures such as DBS, and these possible effects can include:
  • Seizures
  • Migraines
  • Confusion
  • Infections
  • Troubles concentrating
  • Potential stroke
  • Hardware issues
  • Pain and swelling
  • Numbness
  • Muscle tightness
  • Speech, vision, or balance issues
  • Anger
  • Depression
  • Lightheadedness

What Is Obsessive-Compulsive Disorder?

According to the American Psychiatric Association, “Obsessive-compulsive disorder (OCD) is a disorder in which people have recurring, unwanted thoughts, ideas, or sensations (obsessions) that make them feel driven to do something repetitively (compulsions).”7

A person’s compulsions can significantly impact their life by interfering with different activities and obligations. When a person has OCD, choosing to not perform a compulsion can be extremely stressful and difficult. It can be challenging for them to disengage in their compulsive actions or obsessive thoughts.

OCD Symptoms

People with OCD have two different types of symptoms: obsession symptoms and compulsion symptoms. It is common for someone to only have obsessions or compulsions. Normally, people do not realize their behaviors or thoughts are excessive or unreasonable.8 OCD symptoms vary depending on the severity of the case.

Obsessions

OCD obsessions are repeated and unwanted thoughts or urges. Obsessions can be intrusive and cause someone extreme anxiety or distress. Normally, obsessions will have a theme. Some of those themes could be fear of contamination, troubles with tolerating uncertainty, aggressive or horrifying thought patterns about losing control of one’s actions, and unwanted thoughts on aggressive behavior, sexual, or religious topics.8

Some symptoms are as follows:8

  • Irrational fear of being contaminated with germs by touching things that someone else has touched
  • Doubts that you’ve locked something or turned something off
  • Extreme stress when things are not in order
  • Avoiding scenarios that could trigger a compulsion
  • Fantasies of violence
  • Fantasies of acting inappropriately or shouting inappropriate things
  • Unwanted sexual fantasies/images

Compulsions

OCD compulsions differ from obsessions. Instead of thoughts, these are repetitive behaviors that someone feels like they have to perform. Normally, the compulsions are to reduce anxiety or prevent bad things from happening. Normally, the compulsion only brings temporary relief. Compulsions will also have themes, just like obsessions.

Some symptoms include:8

  • Intense handwashing
  • Checking to make sure things are off repeatedly
  • Silently repeating words, phrases, or prayers
  • Checking to make sure things are locked repeatedly
  • Making sure everything is orderly
  • Counting in specific patterns

Deep Brain Stimulation for OCD

DBS is a very effective treatment for people struggling with OCD. It can decrease OCD symptoms in 60% of patients with refractory OCD.9 However, deep brain stimulation is currently a rare treatment option for people with OCD since most patients manage their obsessions and compulsions with medication or therapy. Nevertheless, the use of DBS for treating disorders is growing, especially for patients struggling to see results with conventional methods.

FDA Approving DBS for OCD

The FDA approved deep brain stimulation for obsessive-compulsive disorder treatment. This approval came about after multiple studies showed that DBS could significantly reduce symptoms in patients struggling with severe treatment-resistant OCD.

How Long Will DBS Last?

The length of time for DBS treatment varies per patient. At best, DBS can provide long-term relief of more than eight years for many patients. However, some clients will see less significant results, while others may not find relief from deep brain stimulation at all.9

Other Treatment for OCD

There are many treatment options for people struggling with OCD. Normally, treatment will not result in a cure, but it can help someone gain control of their symptoms so OCD no longer impacts their daily life.

Medications

Many patients will take medications to control their compulsions and obsessions. Doctors tend to prescribe antidepressants first. Some of the approved medications for OCD treatment include:
  • Fluvoxamine
  • Clomipramine
  • Paroxetine
  • Fluoxetine
  • Sertraline

Therapy

Additionally, many people with OCD will go through cognitive-behavioral therapy. Normally, this therapy starts with gradually exposing someone to an object or obsession they fear. The therapist will help the patient learn new ways to resist the urge to do their compulsive routines. This kind of therapy is difficult, but it can lead to a happier, more manageable life.

DBS is a growing treatment to help people with the most severe cases of OCD. As research continues to come out, deep brain stimulation continues to become a trusted treatment plan. If you have any questions about this type of treatment, please reach out to your primary care physician so they can assist you.

Resources

  1. https://www.mayoclinic.org/tests -procedures/ deep-brain-stimulation/about/pac-20384562
  2. https://www.psychiatrictimes. com/ view/deep-brain-stimulation-surgery-ocd-safety-efficacyand-financial-incentives
  3. https://www.ncbi.nlm.nih.gov /pmc/articles/PMC3785222/
  4. https://www.aans.org/en/ Patients/ Neurosurgical-Conditions-and-Treatments/Deep-Brain-Stimulation
  5. https://www.yalemedicine.org /news/deep-brain-stimulation-awake-brain-surgery
  6. https://www.frontiersin.org/ articles/10.3389/fpsyt. 2020.00055/full
  7. https://www.psychiatry.org/ patients-families/ocd/what-is-obsessive-compulsive-disorder
  8. https://www.mayoclinic.org/ diseases-conditions/obsessive-compulsive-disorder/diagnosis-treatment/drc-20354438
  9. https://www.psychiatryadvisor .com/home/topics/anxiety/deep-brain-stimulation-successfully-treats-refractory-ocd-although-targets-vary/

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