People who have obsessive-compulsive disorder or OCD, are tormented by their own repetitive, nagging thoughts, and for many, there's no treatment that offers relief.
But an experimental procedure may provide at least some improvement for patients who have severe OCD, letting them return to work and some semblance of routine.
However, the treatment, spearheaded by a former Cleveland Clinic Foundation neurosurgeon, produces significant side effects, prompting some questions about the therapy's efficacy.
The study tested deep brain stimulation as a possible treatment for OCD. Because an estimated 20% of OCD patients don't respond to drug or behavioral therapies, the researchers hoped that they would be able to find a new way of treating the condition.
THE OCD LOOP
Those with OCD feel as though their brain gets snagged on a particular thought or impulse and it keeps playing the same message over and over again. For example, some people can't resist the nagging desire to wash their hands several times an hour, while others may constantly check the stove to make sure they haven't left it on. Patients who have OCD are unable to control their intrusive thoughts.
The researchers worked with 15 severely disabled OCD patients who had been on prolonged medication and behavioral therapy.
Each patient received deep brain stimulators—electronic devices that work like pacemakers—that were implanted into a fiber bundle located at the front of the brain.
A deep brain stimulator quiets activity in two regions of the brain where OCD patients appear to have abnormal activity, the researchers say.
After receiving the therapy, the patients experienced a 54% improvement in quality-of-life scores, and several were able to return to work.
PROS AND CONS
Some of the specific benefits of the treatment included mood elevation, anxiety reduction, decreased OCD symptoms and increased alertness. But some subjects also experienced depression, memory flashbacks, nausea, vomiting, visual blurring and abnormal heart rhythms, among other side effects.
But lead researcher Dr. Ali Rezai, formerly from The Cleveland Clinic Foundation, says the side effects can be controlled by changing the dosage of electricity to the stimulator.
"Deep brain stimulation has the advantage of being reversible and adjustable. These [side effects] are not chronic and can be eliminated," Rezai explains.
Rezai agrees that a longer-term study is needed before his team embarks on a larger clinical trial. "The results are encouraging, but we need more follow-up before we enroll more patients."
For information on obsessive-compulsive disorder and other related disorders, visit www.ocfoundation.org, an educational and self-help group based in Connecticut.
