For many individuals living with obsessive-compulsive disorder (OCD), standard treatments such as cognitive behavioral therapy and medication provide meaningful relief. But for a small subset of patients, symptoms persist despite multiple attempts at treatment. This group is considered to have treatment-resistant OCD, a condition that significantly interferes with quality of life, daily functioning, and mental health.
For these individuals, a neurosurgical option called deep brain stimulation (DBS) may be considered. DBS has been studied and applied for movement disorders such as Parkinson’s disease for decades, and its use in psychiatric conditions, including OCD, is growing under carefully controlled protocols.
What Is Deep Brain Stimulation?
Deep brain stimulation is a neurosurgical procedure that involves implanting electrodes in specific areas of the brain associated with abnormal activity. These electrodes are connected to a small battery-powered device called a neurostimulator, placed under the skin near the collarbone.
The neurostimulator delivers mild electrical pulses to the targeted brain regions to help regulate activity and reduce symptoms. In cases of OCD, the goal is to interrupt or modulate the brain circuits involved in obsessive thoughts and compulsive behaviors.
Unlike lesion-based procedures that destroy brain tissue, DBS is adjustable and reversible. The stimulation levels can be fine-tuned over time based on the patient’s response.
How Does DBS Help with OCD?
OCD is believed to involve dysfunction in specific brain circuits, especially those linking the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia. These areas are responsible for decision-making, impulse control, and emotional regulation.
In treatment-resistant OCD, this circuit becomes hyperactive. DBS aims to modulate this activity, improving how the brain processes intrusive thoughts and reducing compulsive behavior patterns.
Patients who respond to DBS often report:
- Fewer intrusive and unwanted thoughts
- Reduced urges to perform compulsions or rituals
- Improved mood and emotional regulation
- Better participation in behavioral therapy
Who Is a Candidate for DBS?
DBS is not a first-line treatment for OCD. It is considered only when all standard therapies have failed, including:
- At least two selective serotonin reuptake inhibitors (SSRIs) at appropriate doses and durations
- Cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP)
- Augmentation with other medications, such as antipsychotics
Candidates must also meet strict diagnostic and functional criteria and typically undergo psychiatric and neurological evaluation at a multidisciplinary center.
What the Procedure Involves
DBS is performed in two stages:
- Electrode Implantation:A neurosurgeon places thin electrodes into the targeted brain region using image-guided technology. This is done under local anesthesia, with the patient awake for part of the procedure to ensure accuracy.
- Neurostimulator Placement:A few days later, a pulse generator is implanted under the skin in the chest and connected to the electrodes.
After the procedure, the system is activated and calibrated over several sessions. It may take weeks or months to determine the most effective stimulation settings.
Advanced Neurological Care for Complex Conditions
The physicians at Houston Physicians Hospital offer advanced neurology and neurosurgery services, including evaluation for deep brain stimulation in qualified patients with obsessive-compulsive disorder.
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