| Deep
brain stimulation shows promise as a new treatment for refractory
obsessive compulsive disorder Deep brain stimulation shows promise as a treatment for refractory obsessive compulsive disorder, according to a presentation at the Annual Meeting of the American Association of Neurological Surgeons. Investigators presented preliminary results from an international prospective trial that evaluated use of bilateral deep brain stimulation in 15 people with disease resistant to prolonged medication and use of behavioral therapy. According to the National Institute of Mental Health, the disorder affects 2 to 3 percent of the American population, which means that the disorder is more common than schizophrenia, bipolar disorder, or panic disorder. An estimated 20 percent of affected patients have intractable disease. In the current study, 15 severely disabled patients (7 men, 8 women) whose condition was refractory to prolonged medication and behavioral therapy were enrolled from 1998 to 2002. The average age at symptom onset was 14 years, and the average age at implantation for deep brain stimulation was 36 years. Patients exhibited symptoms that included checking/incompleteness, touching, contamination fears, perfectionism, pervasive rituals, arranging, washing, counting, fear of harming, and intrusive obsessions. Surgery involved implantation of bilateral deep brain stimulators in the anterior limb of the internal capsule. The primary team of caregivers included psychiatrists, neuropsychologists, neurosurgeons, neurologists, neuroradiologists, neurophysiologists and ethicists. In addition, each of the medical centers involved in the study obtained approval from their Institutional Review Boards and an Independent Review Committee comprised of healthcare professionals. Overall, patients reported an improved quality of life following treatment even though some individual effects had a negative impact on quality of life. Reported effects included mood elevation (although sometimes also acute depression), hypomania, anxiety reduction, decreased disorder symptoms, increased alertness and energy, memory flashbacks, irritability, muscle contraction, epigastric and olfactory sensations, nausea, vomiting, visual blurring, facial paresthesias, and tachycardia. "Deep brain stimulation has the advantage
of being reversible and adjustable and is now routinely used for
the treatment of refractory movement disorders," said Ali Rezai,
M.D., the presenter. "This treatment holds promise for the
ongoing treatment of intractable obsessive compulsive disorder."
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