A study carried out by US researchers shows that inserting thin electrodes into the brain can reduce the symptoms of the most severe forms, which do not respond to other treatments. However, it is an invasive procedure.
Deep brain stimulation using very thin electrodes inserted into the brain by a neurosurgeon, can significantly reduce the symptoms of the most severe and otherwise untreatable forms of severe obsessive-compulsive disorder (OCD). This has been demonstrated by a study published in the Journal of Neurology, Neurosurgery & Psychiatry (part of the British Medical Journal group).
OCD can manifest in many different forms and features intrusive and persistent obsessive thoughts (e.g. the obsession of being exposed to dangers that are in reality only imaginary), as well as dysfunctional and ritualised behaviour. This kind of behaviour is often an impossible attempt to overcome these obsessions, which in the most severe cases interfere with day-to-day activity in an increasingly 'disabling' way, to the point where living a normal life becomes impossible.
OCD often manifests at a young age and is accompanied by severe depression and anxiety. Medication and cognitive-behavioural therapy can be very effective, but in about one in ten cases they do not work.
Deep brain stimulation per contratare il doc
Although several studies have suggested that deep brain stimulation (DBS) may be effective in the most severe cases of OCD, the balance between positive factors and issues associated with this technique has not always been quantified.
In an attempt to provide a definitive answer, psychiatrists and neurosurgeons from Baylor College of Medicine in Houston, Texas, carried out a meta-analysis (examining and compared data from every major study published on the subject in recent years) and then announced their conclusions in the Journal of Neurology, Neurosurgery & Psychiatry.
In particular, researchers looked at 34 studies carried out from 2005 to 2021, involving 345 sufferers with an average age of 40 some of whom had untreatable symptoms that had persisted for at least five years. Other patients had severe symptoms that had lasted 10 years (with at least two years of failed attempts at medication). Anxiety and depression, or personality disorders, were very often present, and sometimes in severe forms. All 345 patients studied had been treated with electrodes implanted in the brain, and then monitored for at least two years.
The result, according to the Houston psychiatrists, was that two-thirds of the patients experienced marked benefits, with a clear reduction in symptoms in 47% of cases. A second parameter analysed was the incidence of depression, which decreased in one out of two patients, and was at least partially alleviated in 16% of the cases.
Several problems
However, side effects like infections, convulsions, strokes or the development of new obsessions also occurred (in under 1% of those treated). Almost eight out of ten patients experienced at least one problem of a certain severity, which is not surprising, given that deep brain stimulation is an invasive treatment, and that the mechanisms behind obsessive-compulsive disorder are not fully understood.
As previously stated, brain stimulation involves inserting very thin electrodes into the brain, which reach the areas believed to be responsible for OCD. The operation takes place under local anaesthesia, with the cooperation of the patient, who has to perform a few small actions, like opening and closing a hand, under the directions of the surgeon. This is to check directly that no damage is caused by the neurosurgery as the operation is taking place.
Electrodes are then connected to a small external device (a kind of pacemaker), placed under the skin near the collarbone or in the abdominal area, which produces weak, adjustable electrical charges. These very faint charges interfere with the brain areas involved in OCD and, in many cases, mitigate its effects.
An alliance is needed
DBS has long been used to relieve symptoms, including those of Parkinson's disease. As it is extremely invasive, it should only be used in carefully selected cases, when all other techniques have failed and there needs to be a true therapeutic alliance between the doctor and patient: a close and sincere partnership to help the patient understand exactly what the risks are, and how best to manage a system that, once implanted, requires fine-tuning, with the direct participation of the patient themselves.
