Deep brain stimulation may significantly improve OCD symptoms

The debilitating behaviours and all-consuming thoughts, which affect people with severe obsessive compulsive disorder (OCD), could be significantly improved with targeted deep brain stimulation.

Hand washing with soap. Photo: Serenity/Wikipedia (CC BY-SA 3.0)

OCD is characterised by unwanted intrusive thoughts and repetitive rituals and causes pronounced impairment in everyday life. In very severe cases, OCD patients are unable to leave their house or flat due to fears of contamination.

This repetitive and compulsive behavior is associated with cognitive rigidity or an impairment in cognitive flexibility – an inability to adapt to new situations or new rules.

One treatment for this type of OCD is a form of cognitive behavior therapy called "exposure and response prevention", which involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands.

OCD is also treated with medicines known as selective serotonin reuptake inhibitors, or SSRIs, such as Prozac. But as many as 40% of OCD patients fail to respond to treatment.

Deep brain stimulation (DBS) is an emerging treatment for severe OCD when all other treatments fail.

The study directly compared effects at two different brain locations – the subthalamic nucleus (STN) and ventral capsule (VC) – in the same patients.

The two sites had both previously been identified as being important in OCD, but it had been unclear whether they were simply parts of the same brain network and if they worked on the same type of symptoms.

The researchers show that both sites were remarkably effective in reducing OCD symptoms, but on different aspects: VC stimulation improved mood, while STN stimulation improved cognitive flexibility.

These findings suggest that DBS at these two sites works on different brain circuits, one involving the medial prefrontal cortex and the other the lateral prefrontal cortex. This was also confirmed using brain imaging.

Cognitive flexibility is a major deficit in patients with OCD and is related to the the lateral prefrontal cortex. The new research shows that OCD is also linked to medial prefrontal cortex abnormality.

While DBS is only used when medication and specific psychological treatments have been tried and failed, for some patients it may provide them with the opportunity to regain well-being and quality of life. (University of Cambridge)

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