New research found that deep brain stimulation (DBS) reduced OCD (obsessive compulsive disorder) symptoms by 47% in patients with severe OCD. In addition, about 66% of patients who had access to treatment reported an improvement in symptoms.
OCD consists of two traits that affect the patient: obsession and compulsion. The first concerns a constant thought that the person has regardless of what content it is. On the other hand, the second is an act that the individual does in an attempt to alleviate his obsession.
An example is someone who always thinks their hand is infested with germs – obsession. So this person constantly washes his hands in order to clean them – the latter case is compulsion.
One of the treatment options for severe cases of the disease is DBS, a topic analyzed by the new study published this Tuesday (20) in the Journal of Neurology, Neurosurgery and Psychiatry.
The article is a systematic review, a type of survey that analyzes the results of previous research with a defined methodology. In total, 34 studies published between 2005 and 2021 comprised the review.
When comparing the different results, the authors came to the conclusion that patients with severe symptoms and unresponsive to other treatments indicated for OCD showed substantial gains -reduction of almost half of the manifestations of the disease – with deep brain stimulation.
This procedure is an invasive surgery performed to attach electrodes to specific parts of the brain. In turn, these electrodes are connected to a pacemaker that emits stimulations to the brain.
In addition to OCD, the technique is used to treat other conditions.
“Deep stimulation has been used in neurosurgery for a long time. In psychiatry, it is mostly used for OCD. In neurology, it is widely used for Parkinson’s and other movement disorders”, says Leandro Valiengo, coordinator of the Interdisciplinary Service of Neuromodulation at IPQ ( Institute of Psychiatry) at USP.
Advantages and indications
The positive results for patients is one of the main advantages of DBS, but the procedure is also interesting because it does not leave sequelae after surgery.
Valiengo, who is not one of the authors of the research, explains that OCD is associated with a dysfunction in the basal ganglia, a region deeper in the brain. Therefore, previous techniques targeted this area of the organ. “In the past, surgery was performed to alter these structures.”
The point is that this intervention damaged the brain because electromagnetic radiation was used. When opting for DBS, this does not occur.
“DBS does not injure anything. By placing the electrode in the region, it manages to stimulate or inhibit the basal ganglia”, says Valiengo.
Stimulation also has the advantage of being reversible and also making it possible to change the pattern of stimulation sent to the brain. Depending on the patient’s condition, these changes may be necessary.
The technique, however, is not recommended for every patient with OCD. In fact, it is one of the last treatment options.
Usually, the first ways to treat the condition involve the adoption of medications, especially those that act on serotonin, such as antidepressants. Early on, cognitive-behavioral therapy is also oriented.
If the patient does not respond satisfactorily, other remedies may be prescribed.
It is still possible to perform neuromodulation procedures: an example is transcranial magnetic stimulation that stimulates the brain, but is not invasive surgery.
It is only after these forms of treatment and with unsatisfactory results that an invasive procedure is recommended, which is the case with DBS.