New Treatment for Severe OCD

Deep brain stimulation offers relief from compulsive disorder, but has side effects

TUESDAY, April 29, 2003 (HealthDayNews) -- People with obsessive-compulsive disorder (OCD) are tormented by their own nagging, repetitive thoughts, and for many there's currently no treatment that offers relief.

But an experimental procedure may provide at least some improvement for severe OCD patients, a new study suggests, letting them return to work and pick of the pieces of their interrupted lives.

However, the treatment, spearheaded by a Cleveland Clinic Foundation neurosurgeon, produces significant side effects, prompting some questions about the therapy's efficacy.

The study, which was presented April 29 at the American Association of Neurological Surgeons annual meeting in San Diego, tested deep brain stimulation as a possible treatment for OCD. Because an estimated 20 percent of OCD patients don't respond to drug or behavioral therapies, the researchers hoped to find a new way of treating the condition.

Those with OCD feel as though their brain gets snagged on a particular thought or impulse and, like a skipping record, it keeps playing the same message over and over again. For example, some people can't resist the nagging desire to wash their hands several times an hour, while others may constantly check the stove to make sure they haven't caused a fire.

These rituals may seem benign to the non-sufferer, but OCD patients are unable to control their intrusive thoughts and sometimes require institutionalization, the researchers say.

Between 1998 and 2002, the researchers worked with 15 severely disabled OCD patients who'd been on prolonged medication and behavioral therapy. The subjects included seven males and eight females from Europe and the United States who were, on average, 14 years old when they were struck by OCD.

Each patient received deep brain stimulators -- electronic devices that work like pacemakers -- that were implanted into a fiber bundle located at the front of the brain. A deep brain stimulator quiets activity in two regions of the brain where OCD patients appear to have abnormal activity, the researchers say.

Each month, the patients were evaluated using a battery of psychology and medical tests that measured both their clinical progress and quality of life.

After receiving the therapy, the patients experienced a 54 percent improvement in quality-of-life scores, and several were able to return to work.

Some of the specific benefits of the treatment included mood elevation, anxiety reduction, decreased OCD symptoms and increased alertness. But some subjects also experienced depression, memory flashbacks, nausea, vomiting, visual blurring and abnormal heart rhythms, among other side effects, the researchers say.

The treatment appears to be a mixed bag, offering patients relief from some symptoms while at the same time causing other unpleasant side effects. Moreover, the treatment is invasive and requires brain surgery, which can be a risky undertaking.

But lead researcher Dr. Ali Rezai of the Cleveland Clinic Foundation says the side effects can be controlled by changing the dosage of electricity.

"Deep brain stimulation has the advantage of being reversible and adjustable. These are not chronic [side effects] and can be eliminated," he says.

Dr. Alex Valadka, an associate professor of neurosurgery at Baylor College of Medicine, questions the value of the therapy, given the significant side effects.

"The question is, is it worth it?" Valadka says. "You could be just replacing one bad problem with another bad problem. Before moving forward, I think we'd all feel better if they [the researchers] tried to replicate these results with a few more preliminary studies."

Rezai agrees that a longer-term study is needed before his team embarks on a larger clinical trial: "The results are encouraging but we need more follow-up before we enroll more patients."

More information

To learn more about obsessive-compulsive disorder, visit the National Institute of Mental Health or the Obsessive-Compulsive Foundation.

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