Obsessive-compulsive disorder (OCD) affects approximately 1-3% of the population. It is characterized by unwanted, repetitive thoughts, and behaviors that interfere with daily life. OCD can be treated with medication, therapy, or a combination of both.

However, in severe cases, deep brain stimulation (DBS) has been shown to be a successful treatment option.

What is Deep Brain Stimulation?

Deep brain stimulation is a surgical procedure that involves implanting electrodes into specific areas of the brain. These electrodes are connected to a device similar to a pacemaker that is implanted under the skin in the chest.

The device sends electrical impulses to the electrodes, which can modify the activity of the brain.

How Does Deep Brain Stimulation Work for OCD?

The exact mechanism by which DBS works for OCD is not fully understood, but it is believed to work by disrupting the abnormal patterns of activity in the brain that contribute to OCD symptoms.

Specifically, DBS targets the anterior cingulate cortex (ACC) and the adjacent ventral striatum, areas of the brain that are involved in the regulation of mood, anxiety, and motivation.

DBS works by reducing the activity of these areas, which can help to decrease anxiety and reduce the severity of OCD symptoms.

It is important to note that DBS is not a cure for OCD, but it can be a highly effective tool in the management of the disorder.

Who is a Candidate for Deep Brain Stimulation?

Patients with severe, treatment-resistant OCD may be candidates for DBS. This typically means that the patient has not responded to multiple medication and therapy trials.

A thorough evaluation is needed to determine if the patient is a good candidate for DBS. This may include a physical exam, neurological exam, psychiatric evaluation, and brain imaging studies.

The Procedure

The DBS procedure involves several steps. First, a stereotactic frame is attached to the patient’s head to allow for precise positioning of the electrodes.

Next, magnetic resonance imaging (MRI) and/or computed tomography (CT) scans are used to create a 3D map of the brain. This map is used to guide the placement of the electrodes.

The electrodes are implanted using a thin, insulated wire. The wire is guided through a small hole in the skull and positioned in the target area of the brain.

After the electrodes are in place, the patient undergoes a trial stimulation period. This involves turning on the device to deliver electrical impulses to the brain while the patient is awake.

The patient is asked to provide feedback on the level of stimulation and any changes in symptoms.

If the trial period is successful, the device is fully implanted under the skin in the chest. The patient is typically discharged from the hospital a few days after the procedure.

Results

Research has shown that DBS can be an effective treatment option for patients with severe, treatment-resistant OCD.

A meta-analysis of several studies found that approximately 60% of patients who underwent DBS showed significant improvement in OCD symptoms.

DBS has been shown to be particularly effective in reducing symptoms related to checking, washing, and hoarding behaviors. However, it may be less effective in reducing symptoms related to obsessions or intrusive thoughts.

Risks

As with any surgical procedure, there are risks associated with DBS. These include infection, bleeding, stroke, and device malfunction.

There are also risks associated with the stimulation itself. These risks include mood changes, changes in sexual functioning, and cognitive changes.

Limitations

DBS is not a cure for OCD, and it may not be effective for all patients. It is also a relatively new treatment option, and more research is needed to fully understand its long-term effectiveness and potential side effects.

Conclusion

Deep brain stimulation is a promising treatment option for patients with severe, treatment-resistant OCD. It works by disrupting abnormal patterns of activity in the brain that contribute to OCD symptoms.

While DBS is not a cure for OCD, it has been shown to be highly effective in reducing the severity of symptoms. As with any surgical procedure, there are risks and limitations associated with DBS.

However, for many patients, the potential benefits outweigh the risks.