PILOT STUDY OF DBS FOR TREATMENT-REFRACTORY OCD

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The goal of this research project is to reduce symptom severity and enhance quality of life for subjects with severe and intractable obsessive-compulsive disorder-OCD. Despite advances in the pharmacological and behavioral therapies, a substantial number of patients fail to improve significantly following years of conventional as well as experimental interventions. For some patients, stereotactic neurosurgery is the only promising option left. The available evidence suggests that these procedures may lead to enduring benefits and relatively few side effects in the majority of OCD patients with intractable disease. However, the effects of these ablative techniques on brain tissue and function are irreversible. A team of European investigators reported positive results in three of four intractable cases of OCD using bilateral deep brain stimulation-DBS of the anterior limb of the internal capsule. Independent confirmation by a qualified psychiatric-neurosurgical team is crucial before it gains more widespread use; there are already indications that numerous centers across the country are pursuing it. Although DBS, like ablative surgery, is an invasive procedure with infrequent but serious risks, unlike ablative techniques, DBS is adjustable and partially reversible. The current project is designed to gather preliminary data on the effectiveness, safety, and tolerability of chronic stimulation-DBS via bilaterally implanted electrodes in the anterior limb of the internal capsules of 6 subjects with treatment-refractory OCD that would otherwise be candidates for ablative neurosurgery.