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But investigators point out that results are preliminary and further study is required
SAN DIEGO (April 28, 2003) -- Deep-brain stimulation (DBS), a proven therapy for advanced stages of movement disorders such as Parkinson's disease, shows promise as a potential treatment for the most severe cases of obsessive-compulsive disorder (OCD), according to preliminary results of a clinical research trial presented this week at the 71st Annual Meeting of the American Association of Neurological Surgeons (AANS).
People with OCD suffer from a cyclical pattern of repetitive thoughts and behaviors that are usually senseless and often distressing. According to the National Institute of Mental Health, OCD affects 2 percent to 3 percent of the population (5 million to 8 millions Americans alone), making this anxiety disorder more common than other psychiatric illnesses including schizophrenia, bipolar disorder or panic disorder.
OCD affects men and women equally, as well as all ethnic groups, and spans a spectrum of mild to severe. When severe and left untreated, it can destroy a person's ability to function at work, at school or even at home. An estimated 20 percent of OCD patients are unresponsive to medical and behavioral therapy, and half of this group is severely disabled by the condition. These patients have historically had few viable treatment options. Some are so severely disabled that they must be institutionalized.
As part of the trial, 15 severely disabled OCD patients -- 7 men and 8 women, all of whom were refractory to prolonged medication and behavioral therapy -- received DBS. These patients, some of whom are institutionalized because of the severity of their condition, would usually be considered candidates for surgery in which a portion of the brain is lesioned. Unlike lesioning, though, brain stimulation has the advantage of being adjustable and reversible.
Based upon standardized clinical tests that measure OCD symptoms, as well as evaluation of the patients' overall functional levels:
- 6 patients improved by more than 50 percent
- 6 patients improved by between 25 percent and 50 percent
- 3 patients improved by less than 25 percent
Overall, the patients taken as a group showed an average improvement of 36 percent in the Yale Brown Obsessive Compulsive Scale (YBOCS). Improvements attributed to deep-brain stimulation included "elevated mood, decreased anxiety, improved interpersonal connections and improved functionality," according to the investigators.
None of the patients in the trial experienced permanent complications.
"We're encouraged by the preliminary results, but recognize the need for further study before drawing any definitive conclusions," said Ali R. Rezai, M.D., a neurosurgeon at The Cleveland Clinic Foundation and one of the trial's investigators. "Deep-brain stimulation, which has the advantage of being reversible and adjustable, has been routinely applied to refractory movement disorders for the past several years. Based on our work, it now shows promise in the treatment of intractable obsessive-compulsive disorder."
Patients in the trial, which began in 1998, exhibited symptoms that included checking/incompleteness, touching, contamination fears, perfectionism, pervasive rituals, arranging, washing, counting, fear of harming and intrusive obsessions. The average age of onset of OCD in this group was 14 years old, with DBS implantation occurring at an average age of 36 years.
Patients received treatment at the University of Leuven in Belgium, Brown University/Rhode Island Hospital and The Cleveland Clinic Foundation. The treatment involved the implantation of deep brain stimulation systems made by Medtronic. The stimulating electrodes were implanted in the part of the brain known as the anterior limb of the internal capsule.
An interdisciplinary team with expertise in psychiatry, neurosurgery, neuropsychology, neurology, neuroradiology, physiology and ethics are collaborating on this ongoing trial, which is designed to evaluate the use of DBS of the anterior limb of the internal capsule for medically intractable OCD. Each of the medical centers involved in the study obtained approval from their Institutional Review Boards and an Independent Review Committee comprised of healthcare professionals.
Study authors include Ali R. Rezai, MD, The Cleveland Clinic Foundation; Gerhard Friehs, MD, Brown University; Bart Nuttin, MD, University of Leuven; Scott Rauch, MD, Massachusetts General Hospital; Donald Malone, MD, The Cleveland Clinic Foundation; Paul Cosyns, MD, University of Leuven; Steven Rasmussen, MD, Brown University; and Benjamin Greenberg, MD, Brown University.
The presentation, "Deep Brain Stimulation (DBS) for the Treatment of Obsessive Compulsive Disorder (OCD): Preliminary Results from a Multicenter Prospective Trial," takes place Tuesday, April 29, from 11:45 a.m. to noon.
Read Abstract (PDF 101KB)
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 6,500 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves.
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