New Treatment for OCD Offers Hope To Most Severe Cases
There is a new treatment which offers hope for patients with severe obsessive-compulsive disorder (OCD) for whom conventional drug and behavioral therapy has failed. OCD is estimated to affect one in 50 adults in the United States.
Obsessive-compulsive disorder patients have persistent thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. When severe, OCD can keep a person from working or carrying out normal daily activities. Standard treatments such as medications and cognitive behavioral therapy (CBT).
On Feb 19, 2009, the Food and Drug Administration (FDA) approved Medronic's Reclaim Deep Brain Stimulation (DBS) Therapy for treatment of chronic, severe OCD patients. The device is indicated in adult patients who have failed at least three selective serotonin reuptake inhibitors (ssris). It is estimated that fewer than 4,000 OCD patients per year will fall into the group where DBS therapy is appropriate and necessary treatment. Medtronic plans to make Reclaim DBS Therapy for OCD available in the United States by mid-2009.
The deep brain stimulator is a surgically implanted medical device, similar to a pacemaker, used to deliver carefully controlled electrical pulses to precisely targeted areas of the brain. The stimulation can be programmed and adjusted without additional surgery by a trained clinician to find the most appropriate setting of stimulation for each individual patient.
The neurostimulators used for Reclaim DBS are the same as those used to treat common movement disorders like Parkinson's disease. The area of the brain targeted for OCD is different than those for movement disorders. For OCD, the anatomical target in the brain is the anterior limb of the internal capsule (AIC), and more specifically, a region sometimes referred to as the ventral capsule/ventral striatum (VC/VS), which is a central node in the neural circuits believed to regulate mood and anxiety.
Approval was based on collaborative clinical research of DBS therapy using Medtronic devices began in 1998. The research was conducted at Catholic University of Leuven in Belgium and three U.S. medical centers (Butler Hospital in Providence, R.I., Cleveland Clinic, and University of Florida, Gainesville).
DBS therapy was studied in 26 patients with severe, treatment-resistant OCD. Two-thirds of these patients had significant reductions in symptoms as well as functional improvements. Most of the 26 patients improved from a severe OCD rating to a mild or moderate rating.
It must be remembered that the placement of the DBS device is surgery and therefore carries a risk of life-threatening cerebral hemorrhage and brain infection.
The treatment requires an interdisciplinary team of experts for selecting the right patients, implanting the device, adjusting the electrical stimulation to the brain, and managing patients over the long term.
For more information on OCD
Obsessive Compulsive Foundation