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, according to a new UCL-led study.
OCD is characterised by unwanted intrusive thoughts (obsessions) and repetitive stereotyped behaviours (compulsions – sometimes called rituals) and often means everyday activities become impossible. This repetitive and compulsive behaviour is commonly associated with depressed mood or impairment in cognitive flexibility – an inability to flexibly adapt to changing situations.
Deep brain stimulation (DBS) is an emerging treatment for a small number of people with extremely severe OCD who have not responded to available treatment, such as cognitive behavioural therapy or medication. It requires neurosurgical implantation of electrodes.
In a study published in Biological Psychiatry, six patients with treatment-resistant OCD received deep brain stimulation (DBS) to two brain areas previously associated with OCD.
The study found that DBS at each site significantly reduced OCD symptoms.
In the course of the study researchers also learned more about the roles different brain regions play in OCD, which has potentially important implications for treatment.
Lead author of the study Professor Eileen Joyce (UCL Queen Square Institute of Neurology) said: “This is the first study to compare directly the effects of deep brain stimulation at two brain sites and has discovered important information about how the brain changes in severe OCD responsible for obsessions and compulsions, depressed mood and cognitive inflexibility might be alleviated.”
All patients in the study had been ill for at least 20 years and failed to respond to high doses of medication plus intensive cognitive behavioural therapy.
The main drawback to the study was its small sample size. Researchers said the study conclusions remain robust, but that it would be important to do a further study in a larger group of patients.
