SUNDAY, Feb. 24 (HealthDay News) -- Deep brain stimulation has
helped people with severe obsessive-compulsive disorder, and new
research begins to explain why.
A Dutch study appearing in the Feb. 24 online issue of the
Nature Neurosciencefound the procedure essentially restored
normal function in a part of the brain called the nucleus
The nucleus accumbens "is part of a greater brain network,"
explained study author Dr. Martijn Figee. "This network is involved
in motivation and the processing of rewards, and its activity is
disturbed in [obsessive-compulsive disorder], probably explaining
why [patients] are stuck in pathological behaviors at the cost of
So, obsessive-compulsive disorder (OCD) is essentially the
result of faulty wiring in the brain.
It's not so much a disorder of a specific part of the brain than
it is a "disorder of neurocircuitry," explained Dr. Brian Snyder,
director of functional and restorative neurosurgery at Winthrop
University Hospital in Mineola, N.Y.
About 1 percent of U.S. adults suffer from the condition, which
involves unwanted, intrusive thoughts or obsessions that then spur
While a person without OCD might momentarily worry that he or
she has forgotten to lock the door, that thought is quickly
balanced by the realization that, yes, the door has indeed been
For a person with OCD, on the other hand, the thought that the
door is unlocked will recur and fall into a repetitive pattern of
thinking (obsession) and checking to make sure the door is locked
Dr. Wayne Goodman, professor and chair of psychiatry at Mount
Sinai Hospital in New York City described OCD as a kind of
Deep brain stimulation (DBS), which is widely used for severe
Parkinson's and experimentally to treat major depression, has
limited approval in the United States to treat OCD that hasn't
responded to other treatments.
But experts haven't been sure why the procedure worked.
This study involved 16 patients with OCD and 13 healthy
controls, all of whom had electrodes implanted in the nucleus
accumbens area of the brain. They then underwent functional MRI
brain scans while performing a task that involved the anticipation
of reward (the type of activity that might trigger OCD).
OCD symptoms improved an average of 50 percent while brain
activity -- not only in the nucleus accumbens but also in a larger
brain network -- was normalized, said Figee, who is a psychiatrist
with the DBS psychiatry department at Academic Medical Center in
Amsterdam, the Netherlands.
"This may explain why patients with DBS experience very fast changes in a wide array of motivational and behavioral problems," he added. "This is clinically important because it indicates that DBS could also help for other disorders that have similar network disturbances, like addiction or eating disorders."
Several centers in Europe and the United States now use DBS for
psychiatric illnesses, said Figee.
Accessibility and insurance coverage vary greatly, although
Medicaid sometimes covers it, said Goodman.
But choosing appropriate candidates for the procedure can be
daunting, as they need to have failed multiple medications as well
as cognitive behavioral therapy, said Snyder. Cognitive behavioral
therapy is a treatment that helps patients try to change their
thoughts, feelings and behaviors. The patients also need to be free
of other psychiatric disorders.
Although benefits appear to be long lasting, the procedure is
not a cure, Snyder noted.
"It provides significant symptomatic benefits," he said. "It could mean the difference between being able to go out of the house and going to a job and being stuck in the house or an institution all the time."
U.S. National Institute of Mental Healthhas more
on obsessive-compulsive disorder.
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