A new study has suggested that using electrodes to stimulate areas deep within the brain are likely to be an alternative therapy for patients with obsessive compulsive disorder that is resistant to treatment.
Current treatments for the Obsessive-compulsive disorder (OCD) include cognitive behavioural therapy and medication.
AdvertisementThese therapies work for only half of patients and reduce symptoms by an average of 40 to 60 percent. An estimated 10 percent of patients remain severely affected by OCD despite receiving the best available treatments.
Damiaan Denys of the University of Amsterdam and colleagues assessed the safety and effectiveness of deep brain stimulation among a group of 16 patients whose OCD had not responded to previous rounds of treatment.
The study consisted of three treatment phases. After having electrodes implanted in the nucleus accumbens, a brain area critical to the reward system, all participants underwent an open phase of eight months during which they received active stimulation and were assessed for symptoms of OCD every two weeks.
After the open phase, patients entered a one-month, double blind phase in which they were randomly assigned to have the electrodes turned on or off in two-week blocks.
Their symptoms were assessed before this phase and after each two-week block. Then, all patients entered a 12-month maintenance phase, during which stimulation was resumed and they were evaluated at three-month intervals.
The researchers ranked obsessive-compulsive symptoms on a scale of zero to 40; patients were classified as responding to treatment if they had a score decrease of at least 35 percent. In the open phase of the study, the average score decreased from 33.7 to 18.0 (46 percent). Among the nine patients classified as responders, scores decreased by an average of 23.7, or 72 percent.
"Anxiety and depressive symptoms decreased by half.
"The surgical procedure and stimulation were well tolerated. Permanent adverse events were limited to mild forgetfulness and word-finding problems," wrote the authors.
During the double-blind phase of the study, in which 14 patients participated, the average difference in score between those receiving active stimulation and those receiving false or "sham" stimulation was 8.3, or 25 percent.
The improvements observed in the open phase were sustained over the 12-month maintenance phase.
"In summary, the results of this study indicate that bilateral stimulation of the nucleus accumbens may be an effective and safe treatment in patients with highly refractory OCD and support the therapeutic potential of deep brain stimulation in patients with incapacitating chronic psychiatric disorders," concluded the authors.
The findings were published in the Archives of General Psychiatry, one of the JAMA/Archives journals.
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