To print: Select File and then Print from your browser's menu --------------------------------------------------------------------------------------- Title: Brain Stimulation an Option for Severe Obsessive-Compulsive Disorder: Presented at ECNP URL: http://www.pslgroup.com/dg/215E9A.htm Doctor's Guide October 17, 2007
By Joanna Lyford VIENNA, AUSTRIA -- October 17, 2007 -- Deep-brain stimulation is an effective, albeit drastic, treatment option for patients with severe obsessive-compulsive disorder (OCD), Dutch researchers stated here at the 20th European College of Neuropsychopharmacology (ECNP) Congress. Their conclusion is based on a series study of 12 patients with severe, treatment-refractory OCD, nine of whom showed a significant improvement in symptoms following neuromodulation therapy targeting the nucleus accumbens, said lead investigator Damiaan Denys, MD, PhD, Neuroscientist, University of Amsterdam, University Medical Center, Utrecht, The Netherlands. Neuromodulation led to a dramatic improvement in OCD severity in nearly all patients, Dr. Denys stated at a Breaking News session. Compared with baseline, scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decreased in 11 of 12 patients, with reductions ranging from 24% to 97%. Nine patients showed at least a 25% reduction and eight at least a 35% reduction on the Y-BOCS. Dr. Denys explained that deep-brain stimulation, also known as neuromodulation, uses implanted electrodes to deliver electrical stimulation to precise areas of the brain. This alters signal transmission in the nervous system with the aim of "retuning" the neural network activity, potentially producing therapeutic effects. Neuromodulation is usually used in neurologic disorders. OCD is the first psychiatric condition to be treated with this approach. In this ongoing study, Dr. Denys notes that the patients "were severely impaired. The minimum disease duration was 5 years, they were symptomatic for 8 to 10 hours each day, and all had failed to respond to three or more pharmacologic therapies." Treatment involved placing an electrode in the nucleus accumbens, and attaching it to a battery implanted in the chest wall. The electrode has four contact points, and each can be turned on or off using a separate, handheld device. Following electrode placement, patients enter an "optimisation" phase during which different contact points are stimulated to different degrees to achieve an optimal therapeutic effect. "Typically, the obsessions and compulsions became less severe, and patients became more sociable, often participating in activities that would have been unthinkable before treatment," said Dr. Denys. "For example, a patient with a pathological fear of contamination visited a farm and no longer showered for up to two hours before going to bed." Intriguingly, these effects occurred within minutes or hours of achieving correct neurostimulation. Yet patients lacked insight into their response, and typically said they were no better after neuromodulation, despite objective evidence to the contrary. "The pattern of symptom improvement gives us a new perspective on the pathophysiology of OCD," he said. "It supports the notion that curing the brain entails healing the mind." The optimisation phase of the study will last up to 8 months. At this point, patients will enter a 4-week, double-blind crossover study when the electrodes will be switched on or off. This will allow the treatment effect to be assessed in a controlled manner, Dr. Denys said. Patients will then be followed for 1 year to determine the treatment's long-term efficacy and safety. Results are expected some time in 2008. OCD is a complex and poorly understood psychiatric disorder that can cause sufferers marked distress. Pharmacologic treatment options for OCD are ineffective in many patients, said Dr. Denys, highlighting the need for novel therapeutic approaches. The use of deep-brain stimulation is based on preclinical and clinical evidence suggesting that mesolimbic dopaminergic neurotransmission is dysfunctional in OCD. In particular, there is evidence of the involvement of dopamine D2 receptors in the nucleus accumbens. [Presentation title: Deep Brain Stimulation of the Nucleus Accumbens in Treatment-Refractory Obsession Compulsive Disorder. Presented at Symposium S13: Breaking News 2] --------------------------------------------------------------------------------------------- Copyright © 1999 P\S\L Consulting Group Inc. All rights reserved. Republication or redistribution of P\S\L content is expressly prohibited without the prior written consent of P\S\L. 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