Deep Brain Stimulation (DBS)

Deep Brain Stimulation (DBS) is a highly experimental neurosurgical treatment for OCD in which the brain is stimulated with electrical impulses.

Electrical deep brain stimulation is a relatively new technique and developed as a treatment for OCD through collaboration between Belgian and Swedish researchers. The effects of electrical stimulation of the brain have been previously investigated during stereotactic surgery for OCD before permanent lesions were made. However, the therapeutic use differs in that electrodes are implanted within brain structures, which are then stimulated via an external electrical source. Any lesions that result are not deliberate and are considered to be small relative to those made deliberately during ablative procedures.

Although it has shown considerable promise in the treatment of movement disorders such as Parkinson’s disease, there is a widely reported growing body of evidence that it may be helpful for the treatment of OCD.

However, because different techniques have been used and diverse brain areas targeted, it has been difficult to compare the results. These preliminary trials hold promise, but it's important to note that this is still an experimental treatment for OCD.

The United States Food and Drug Administration (FDA) recently granted what’s known as a ‘humanitarian device exemption’ for DBS for the treatment of OCD.  But the FDA said its decision was based on a study of just 26 patients with severe OCD that showed only a 40 percent reduction in symptoms after a year of DBS.

Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the implantation of removable electrodes. The way in which DBS works is still unknown, but essentially, DBS uses high frequency pulses that have complex effects including blocking of the targeted area and mimics the effect of tissue lesioning without destroying them and  it has been suggested that it restores normal activity to areas of the brain that have become dysregulated.

Despite widely reported claims that DBS is a safe and reversible procedure, the side effects reported so far suggest extreme vigilance especially as it is not yet established whether DBS is completely reversible.

Any surgical procedure carries risks. Because DBS involves brain surgery, the procedure may be especially risky, posing some serious health risks. Also, the brain stimulation itself may cause side effects.

Possible surgical complications and side effects and adverse health problems associated with DBS include, but may not be limited to:

  • Bleeding in the brain
  • Stroke
  • Infection
  • Breathing problems
  • Nausea
  • Heart problems
  • Incision scarring
  • Seizure
  • Delirium
  • Unwanted mood changes, such as mania and depression
  • Movement disorders
  • Lightheadedness
  • Insomnia
  • Dizziness
  • Device malfunction
  • Temporary tingling in your face or limbs

Also, people who have undergone deep brain stimulation to treat Parkinson's disease have reported a variety of problems, including:

  • Panic attacks
  • Mania
  • Speech difficulty
  • Movement problems
  • Increased suicidal thoughts and behaviour

The long-term risks and side effects of DBS still aren't known , but there is still a growing trend amongst health professionals, particularly in the United States to be treating DBS far too lightly as safe and reversible procedure, which simply is not the case.

In a report to the Scottish Executive in 2006, Professor Keith Matthews from the Dundee Advanced Interventions / Neurosurgery for Mental Disorder (NMD) Service wrote that  DBS is not, as it is often misrepresented by some clinicians and by the media, a simple treatment to deliver, nor is it free from significant hazard.

It should not be forgotten that DBS procedures lead to the creation of lesions, although these are smaller than for ablative procedures and, in some circumstances, may be temporary. Although there are preliminary reasons to view DBS with considerable optimism as a potentially major advance in the management of severe and treatment-refractory depression and OCD, there are also compelling reasons for caution.

The report reported that experience with DBS for movement disorders like Parkinson’s Disease confirms that, despite the widespread acceptance and availability of the treatment, there are continuing difficulties with targeting of electrode placement for optimal efficacy, the development of standardised pre and post treatment protocols, the acquisition and training of an appropriate multidisciplinary team and in developing rational responses to inevitable treatment failures. DBS is an intracranial surgical procedure and serious adverse events can, and do, occur. There is a developing assumption that DBS will present lower risks of adverse events in the likely target populations for treatment of depression and OCD than with movement disorders.

Even if the assumptions of reversibility and reduced morbidity with DBS for psychiatric disorder prove correct, within the populations previously treated by DBS for movement disorders, it is  important to acknowledge that serious adverse effects are not uncommon (13%). These can include direct physical effects from the surgical procedure itself (eg intracranial bleeding, confusion), indirect effects as a consequence of stimulation (mood change, psychotic symptoms) and equipment failures.

The many unresolved difficulties  associated with the treatment suggest that an uncritical acceptance of its superiority over ablative neurosurgery would be unwise. We remain concerned that the provision of DBS, in isolation, in the absence of the support of a skilled multidisciplinary team, would be unacceptable and inappropriate.  

At this time OCD-UK do not recommend DBS as a treatment for OCD and remain concerned that the dangers associated with the procedure continue to be overlooked by the medical community when much safer and less invasive treatments remain available. We will however continue to follow with interest, and reserve the right to change our view when more evidence becomes available.

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