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Offering Hope to Most Severe Cases of OCD Through a New Treatment


Offering Hope to Most Severe Cases of OCD Through a New Treatment

People with severe obsessive-compulsive disorder (OCD) for whom conventional drug and behavioral therapy has failed, can now have hope with this new treatment. People with OCD have persistent thoughts or obsessions, and they use rituals or compulsions to control the anxiety that is produced by these thoughts.

OCD can keep a person from working or carrying out normal daily activities when it is severe. Cognitive behavioral therapy (CBT) and medications are the standard treatments used in treating OCD.

For treating patients with chronic, severe OCD, the FDA approved Medronic’s Reclaim Deep Brain Stimulation (DBS) Therapy on February 19, 2009. The device is indicated in adult patients who have failed at least three SSRIs (selective serotonin reuptake inhibitors).

Used to deliver carefully controlled electrical pulses to precisely targeted areas of the brain, the deep brain stimulator, which is a surgically implanted device, is similar to a pacemaker. To find the most appropriate setting of stimulation for each individual patient, a trained clinician can program and adjust the stimulation without additional surgery.

The same neurostimulators that are used to treat common movement disorders like Parkinson’s disease are also used for Reclaim DBS. However, the area of the brain that is targeted for OCD is different than those for movement disorders. The anatomical target in the brain for OCD is the AIC (anterior limb of the internal capsule), more specifically, a central node in the neural circuits believed to regulate mood and anxiety, which is a region sometimes referred to as the ventral capsule/ventral striatum (VC/VS).

DBS therapy was studied in 26 patients with severe and treatment-resistant OCD. 2/3 of these patients experienced functional improvements in addition to significant reductions in symptoms. Most of the 26 patients improved from a severe OCD rating to a mild or moderate rating.

The fact that the placement of the DBS is done surgically carries a risk of brain infection and life-threatening cerebral hemorrhage. To select the right patients, implant the device, adjust the electrical stimulation to the brain and manage patients over the long term, this treatment requires an interdisciplinary team of experts.

 

POTENTIAL SIDE EFFECTS OF DEEP BRAIN STIMULATION:

Deep brain stimulation may cause some of these side effects:
 

  • Dizziness or lightheadedness (disequilibrium)
  • Reduced coordination or movement problems
  • Tingling sensation (paresthesia)
  • Numbness (hypoesthesia)
  • Facial and limb muscle weakness or partial paralysis (paresis)
  • Worsening of symptoms
  • Jolting or shocking sensation
  • Speech problems (dysarthria, dysphasia)
  • Abnormal, involuntary muscle contractions (dystonia, dyskinesia)


By adjusting the stimulation settings, many of the side effects that are related to stimulation and usually transient can be managed. To find the right stimulation settings to optimize symptom control and minimize side effects, the patient may need several follow-up visits.

 

POTENTIAL SURGICAL RISKS:

The risks that are associated with any other brain surgery are also found in implanting the DBS:
 

  • Neurological complications that can be either temporary or permanent
  • Leakage of cerebral fluid surrounding the brain
  • Headaches
  • Seizure
  • Pain at the surgery sites
  • Infection
  • Intracranial hemorrhage
  • Attention problems or confusion
  • Allergic response to implanted materials
  • Paralysis, coma, death


You can find more information about these risks from a neurologist.
 

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Prepared By: Dr. Mehyar Al-Khashroum
Edited By: Miss Araz Kahvedjian




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