We follow a strict procedure for treatment refractory OCD patients who are considered possible candidates for neurosurgical treatment. First of all, an application file must be sent in. It must be completed by the treating psychiatrist, and list all comorbidities and treatments (psychopharmacological and psychotherapeutic). This form must be documented with all available records of former treatments (both out- and in hospital, psychotherapeutic and psychopharmacologic, and obtained results, if any).
In addition, the patient will undergo a number of psychological tests and/or physical exams. These records will be provided to the members of the Independent Review Group (IRG).
This IRG committee is a multicenter, multidisciplinary advisory board that considers every patient and advises whether he/she fulfills criteria for such treatment. Selection of patients is a careful process, so that patients who are are unsuitable or unlikely to benefit do not undergo the surgery unnecessarily. The inital review and evaluation process may take a number of months.
If the IRG approves a patient for participation in the study, they will then undergo additional testing as well as MRI and other scans. The surgery itself may be performed as a single procedure or divided into two stages at the discretion of the surgeon. For a brief description of the procedure see our home page. There will be a 2-4 week recovery period before the patient begins the next phase of the study.
This is a double-blind controlled trial. This means that for the first portion of the study patients will be divided into two groups. One group will have their DBS turned on and the other will not. During that phase neither the patients nor some of the study clinicians will not know if the DBS has been turned on or not. After that phase, all patients will have their DBS turned on and adjusted to the most optimal setting.
Follow-up visits to the study center during the first year of the study will be relatively frequent (ranging from every 2 weeks to every couple months). After that, follow-up visits will occur approximately every 6 months. During a follow-up visit patients will undergo a number of psychological tests and will be evaluated by the study psychiatrist. Their DBS will be adjusted as necessary.