Patients with OCD get persistent, upsetting thoughts (obsessions) and use rituals (compulsions).
Though these rituals are performed to control the anxiety these thoughts
produce, they often end up controlling the patient. Compulsions include hand-washing, counting, checking, or cleaning. For example
a patient may develop a compulsion to wash his/her hands over and over again.
Severe OCD can keep a person from working or carrying out normal responsibilities
Large epidemiological studies found that OCD
was the fourth most common psychiatric disorder with a lifetime prevalence of
. It is
highly prevalent and more prevalent than the schizophrenia and bipolar
Routine treatment modalities
for OCD include management with certain medications and/or exposure-based
psychotherapy. There are however refractory cases where a patient continues to
suffer severe OCD despite taking multiple medications.
Alternatives in such cases
• Surgical procedure (anterior
- this involves manipulation of the 'cingulate' part
of the brain
Deep brain stimulation
: Abnormal brain activity is
disrupted using electrical stimulation
The search for a more
efficient technique has been on for a while. A new experimental procedure
called radiosurgery gifts hope for severe OCD. In this process a piece of
equipment called a "gamma knife" is used to
deliver an intense beam of radiation. This
radiation is targeted to the anterior cingulate cortex, the area responsible
for the OCD symptoms. Radiosurgery was originally developed as an alternative
to surgery in the treatment of brain tumours.
Three patients (two women
and one man) with extremely severe OCD who failed to respond to medications underwent
radiosurgery. The procedure was completed without any complications and they
were followed up to 4.5years. Significant functional improvements and reduction
in OCD behaviour were noted. They had to continue their medications though.
is not devoid of disadvantages:
stimulation patterns can't be adjusted as in DBS
advantage, however is that unlike DBS, radiosurgery avoids equipment-related
complications. It doesn't require implanted electrodes and generator.
research is solicited before radiosurgery may be prescribed on a wider scale.
January 2011- Volume 68