DBS FOR SEVERE, TREATMENT REFRACTORY OBSESSIVE COMPULSIVE DISORDER. The idea that brain surgery can help someone suffering from a mental illness is still a controversial and, to many people, a confronting one. However, there is now firm evidence that a procedure called Deep Brain Stimulation (DBS) can improve the lives and relieve the crippling and distressing symptoms for some people suffering from very severe obsessive-compulsive disorder (OCD). There have now been four placebo-controlled trials (one of which was Australian) providing firm evidence of this. A ‘viewpoint’ article* in the Australian and New Zealand Journal of Psychiatry argues: that this treatment should no longer be considered ‘experimental’; that it should be reserved for severe ‘treatment-refractory’ illness; and that it should only be carried out at specialised centres with “an experienced multidisciplinary team involved in workup, implantation and follow-up and also where frameworks are in place to provide careful clinical governance and ensure appropriate fully informed consent”.
Deep Brain Stimulation is now a widely accepted and effective treatment for some movement disorders (dystonia, essential tremor, Parkinson’s disease) and less commonly for some forms of epilepsy. It involves neurosurgical implantation of ‘leads’/electrodes in particular areas of the brain. These are connected via an ‘extension’ under the skin to the Implantable Pulse Generator (IPG), also under the skin, usually near the collarbone. This arrangement and the associated technology are similar to those used for cardiac pacemakers. When the person has recovered from the surgery, the IPG is programmed by holding another device over the IPG. The IPG can then deliver electric stimulation to the brain, with the nature, degree and sometimes site of stimulation programmed and, if indicated, varied from time to time. Site variation is possible if the lead has several electrodes at different points. Two virtues of DBS are: the program of stimulation can be varied or ceased according to response, lack of response or adverse effects; the efficacy can be tested in a properly controlled trial, with informed consent, using ‘sham’ or ‘placebo’ stimulation.
*Australian & New Zealand Journal of Psychiatry 2022, Vol. 56(5) 430-436
DOI: 10.1177/00048674211031482