Amsterdam - OCD can be alleviated by deep brain stimulation of the nucleus accumbens ease. For this result, a small double-blind study comes in the Archives of General Psychiatry (2010: 67: 1061-1068).
The DBS was originally developed to treat Parkinson's disease, where it relieves the motor symptoms such as tremors. Meanwhile it is also evaluated for the treatment of psychiatric disorders such as depression and obsessive compulsive disorder.
offers case of OCD, the bilateral stimulation of the nucleus accumbens to the destination. He is part of the neural reward system of the brain. His patients could be switched on, snapping the tormenting them persistent "obsessive" thoughts and repetitive "ritualized" behavior free.
comes as invasive therapy a deep-brain stimulation for Damien Denys from the University of Amsterdam Academic Medical Center is only open when a considerable psychological strain is present and no medical treatment Relief had procured. The 16 participants in the study had been more than 5 years from severe OCD (Obsessive Compulsive Scale Yale-Brown Y-BOCS 28 of 40 points or more) had failed and at least three drug therapies.
All patients were placed in a stereotactic procedure bilaterally advanced multiple probes in the nucleus accumbens. The study consisted of three phases. On an eight-month open phase, looking at the for an optimal strength of deep brain stimulation, was joined a one-month double-blind phase, knew where neither patients nor investigators that the devices were turned on or not, which was for two weeks of the case. Thereafter, the patient over 12 months under the activated deep brain stimulation observed.
showed in the open phase, that therapy is not always achieved their goal. In seven patients, the Y-BOCS are not reduced significantly. This could be located, according to Denys of a non-optimal placement of the electrodes have or the fact that some patients may experience the disorder as egosyntonisch ie not a pathological, which can be perfectionists in the case.
Anyway: In 16 patients experienced during treatment to a very marked reduction of the Y-BOCS at an average of 23.7 points, corresponding to a relative decrease of 72 percent. The difference with the sham-deep brain stimulation in the middle phase in these patients was only 8.3 points or 25 percent relative, so that a certain placebo effect probably can not be excluded.
Since the therapy is not without side effects, it is likely to remain limited to patients who otherwise can not be helped. In addition to the complications of surgery, deep brain stimulation may also trigger even side effects. This includes excessive lifting of the state of mind to hypomanic symptoms, occurring in every second patient.
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