Brain Stimulation for Severe OCD

December 31, 2011 - The departments of Psychiatry and Surgery, Division of Neurosurgery, at the University of Arizona College of Medicine have collaborated to provide the first case of deep brain stimulation for severe, treatment-resistant obsessive compulsive disorder in the state of Arizona.

"We are proud that our collaboration has resulted in providing innovative care for our patients," says Francisco Moreno, MD, Interim Chair and Professor of Psychiatry. "This brings us much hope," he adds.

Deep brain stimulation (DBS) originally was approved by U.S. Food & Drug Administration (FDA) in 1997 for patients with Parkinson's disease. Since then, DBS has been expanded for use including essential/familial tremor, intractable pain, and treatment-resistant depression.

For more than ten years, researchers have been investigating the use of DBS for psychiatric disorders. The first medical device to receive FDA approval for use in chronic, treatment-resistant obsessive compulsive disorder (OCD) is called the Reclaim DBS System from Medtronic. This was made possible through a humanitarian device exemption from the FDA. Humanitarian use devices are regulated by the FDA for the treatment of medical conditions affecting fewer than 4,000 patients per year. To receive approval, a company must demonstrate the product's safety and probable benefit.

For any medical center to be able to offer the DBS for OCD, approval is required from an Institutional Review Board, a committee that approves, monitors and reviews research. The University of Arizona (UA) Human Subjects Protection Program in coordination with the Southern Arizona VA Health Care System (SAVAHCS) Research & Development Committee oversee this project, open through the collaboration between Psychiatry and Neurosurgery programs at UA and SAVAHCS.

When OCD becomes severe, it can keep a person from working or carrying out normal daily activities. Standard treatments such as medications and cognitive behavioral therapy (CBT) fail to work for a subset of people with OCD. DBS delivers adjustable, reversible, non-drug electrical stimulation to areas in the brain to help control symptoms of severe, treatment resistant OCD.

The system uses a surgically implanted medical device, similar to a pacemaker, to deliver the carefully controlled electrical pulses to precisely targeted areas of the brain. It can be programmed and adjusted non-invasively (without surgery) to find the most appropriate type and amount of stimulation to maximize symptom control and minimize side effects. The stimulation may also make it easier for a person to engage in cognitive behavior therapy, which may also help control symptoms.

DBS therapy for treatment-resistant OCD requires close collaboration between the patient's neurosurgeon and psychiatrist. Jean-Philippe Langevin, MD, Clinical Assistant Professor of Surgery at the University of Arizona and Staff Neurosurgeon at SAVAHCS, partners with Dr. Moreno to provide this option to patients at UA. "A collaborative approach is essential to insure the safety of the patients but also to maximize the potential benefits of the therapy," explains Dr. Langevin. He completed his neurosurgery residency and functional neurosurgery fellowship at University of California Los Angeles in Los Angeles, Ca.

Special thanks to the University of Arizona Medical Center and to Medtronic, Inc. for donating hospital time and device for the state's first case.