Deep brain stimulation (DBS) may help people suffering from severe OCD who have not benefited from conventional treatment (behavior therapy and medication). DBS was originally used to treat people with Parkinson’s disease and other movement disorders. Since its inception in the late 1980s, over 35,000 patients worldwide have received DBS for movement disorders. More recently, researchers have recognized the potential for treating OCD with DBS. Unlike permanent lesion procedures (e.g., gamma capsulotomy or cingulotomy), which are already being used as treatments for OCD, DBS is adjustable and reversible.
Studies in the US and Europe beginning in 1998 indicated that most OCD patients who had DBS in the brain circuit targeted by capsulotomy (the ventral capsule/ventral striatum, or VC/VS) experienced improvement. OCD symptoms lessened in severity, which was reflected by an increased ability to perform the functions of daily life. Many patients returned to school or work, became more socially engaged,and resumed living independently. Although the exact causes of this amelioration are still being investigated, one important factor appears to be that after receiving DBS, patients were able to engage in behavior therapy successfully for the first time.
What is DBS?
In DBS, electrodes are implanted in targeted areas of the brain, guided by MRI with millimeter accuracy. Electrical pulses produced by the electrodes change the functioning of brain circuits thought to be involved in obsessions and compulsions. Stimulation is produced by two pacemaker-like devices that are implanted in the chest. These devices are connected to the brain electrodes by wires running under the skin. The DBS settings (intensity, frequency, pulse width, and stimulation of specific electrodes) are adjusted by a remote control that is held up to the chest and communicates via radio waves. Manipulation of these settings allows the effectiveness of DBS to be maximized and any associated side effects to be reduced.
DBS for OCD Study
Motivated by success in the initial smaller-scale studies of DBS for OCD (with 26 patients), we are presently recruiting new patients who may be interested in participating in a similar study. After this current study concludes, we expect to have sufficient data on the effectiveness and tolerability of DBS for OCD to endorse the use of this procedure on a wider basis for OCD patients who have exhausted conventional therapies. Clinical sites, Butler Hospital (Providence, RI), Massachusetts General Hospital (Boston, MA), and the University of Florida (Gainesville, FL) are collaborating in this study. Research has been pursued the longest at Butler Hospital (since early 2001), but all sites have specific experience with DBS for OCD. There is an associated brain imaging study at Massachusetts General Hospital (Boston, MA). The doctor in charge of the overall study is Benjamin Greenberg, MD, PhD, a psychiatrist at Butler Hospital and Brown Medical School. The study is sponsored by the National Institute of Mental Health (NIMH), with DBS devices from Medtronic, the device manufacturer. People with OCD who are interested may contact us about this work at any time.
Consult the comprehensive list of Frequently Asked Questions for answers to various concerns you may have regarding the study. More information can also be obtained from the NIMH page for clinical trials. The remaining sections under this category provide additional details about the process required for people who are interested in participating.