Deep Brain Stimulation


There are a few patients with major depressive disorder or obsessive compulsive disorder whose symptoms are non-responsive or only modestly responsive to all the traditional therapies. If their symptoms become overwhelming for them, they may consider a relatively new, minimally invasive surgical procedure known as Deep Brain Stimulation (DBS).


In the last several decades, a very sophisticated brain imaging technology known as functional magnetic resonance imaging (FMRI) has been developed. With this tool, doctors are able to view the inner workings of the brain. Thus, the biological and anatomical basis of obsessive compulsive disorder (OCD) is finally starting to be explained. As the areas and specific circuits of the brain that react in OCD differently than in the non-OCD brain are identified, treatments that target these particular areas are being developed to reduce the OCD symptoms that have failed to respond to conventional therapies.


One such treatment is called deep brain stimulation, in which removable electrodes are implanted at the target locations in the brain and thus can be precisely stimulated. How it works is yet to be completely understood, but it appears to restore normal activity to those parts of the brain in which circuits have become dysfunctional and in which the electrodes are consequently planted.


Deep brain stimulation has several advantages over traditional brain surgery to treat OCD and major depression, as well as other types of maladies (e.g., chronic pain, essential tremor, or Parkinson’s disease). First, it can reduce symptoms with very little risk of permanent changes in the brain. Second, treatment can be customized, so to speak, by adjusting the stimulation (i.e., stronger or weaker and continuous or intermittent). Finally, although any surgery has its risks, this procedure is minimally invasive, so the side effects are likely to be fewer and less serious than for other surgeries. There is potential for complications and side effects, however, which should be considered.