For adult patients with chronic, severe obsessive-compulsive disorder (OCD) who do not respond well to medication or cognitive-behavior therapy, deep brain stimulation (DBS) may provide some relief from the recurrent, unwanted thoughts and/or repetitive behaviors of the anxiety disorder. Best results are achieved when the patient and caregiver are fully informed about the therapy risks and probable benefits, surgical procedures, follow-up requirements, and self-care responsibilities.
Probable benefits of Medtronic DBS
Reduces symptom severity as defined by the clinical rating scale Yale-Brown obsessive-compulsive scale (YBOCS)
Offers the first safe† access to MRI anywhere on the body for diagnosing health conditions in patients with DBS
Allows therapy to be turned off or reversed, preserving options for future therapies and treatments
Use extreme care with lead implantation in patients with a heightened risk of intracranial hemorrhage. Physicians should consider underlying factors, such as previous neurological injury or prescribed medications (anticoagulants), that may predispose a patient to the risk of bleeding.
Physicians should be aware that the risks associated with initial surgery may increase with clinical conditions such as:
Stroke or neurological disorders
Cardiovascular disease
Renal or hepatic failure
Diabetes mellitus
To help ensure maximum benefits from the neurostimulation system, long-term, post-surgical management of patients is recommended.
Stimulation parameters should be adjusted such that maximal symptom improvement is achieved with minimal side effects. High-parameter values may indicate a system problem or less-than-optimal lead placement. Patients should be informed of the risks of higher stimulation parameters, which may result in possible excessive charge density. Refer to the information for prescribers, addendum for OCD for more information about excessive charge density.
Is your patient a candidate for DBS therapy?
Deep brain stimulation may be considered for patients who meet the following criteria:
Have a diagnosis of OCD with a documented duration of at least five years
Have OCD rated as a severe or chronic extreme illness
Have a YBOCS score of greater than or equal to 30
Have comorbid depression and anxiety
Have failed to improve following treatment with at least three selective serotonin reuptake inhibitors (SSRIs) with augmentation
Do not have hoarding as their primary subclassification
Have completed or tried to complete cognitive behavior therapy (CBT)
Have no serious psychiatric disorder in addition to OCD (e.g., comorbid personality disorder) or substance abuse issues
Meet established criteria for implantation of a deep brain stimulation system
Are 18 years old or older
Have not had a previous surgery to destroy the region of the brain that will be the target of stimulation
Are not pregnant
Have no other neurological disorders, including dementia
Do not have a bleeding disorder or are not taking blood thinners
Humanitarian device: Authorized by federal law (United States) for use as an adjunct to medications and as an alternative to anterior capsulotomy for treatment of chronic, severe, treatment-resistant obsessive-compulsive disorder (OCD) in adult patients who have failed at least three selective serotonin reuptake inhibitors (SSRIs). The effectiveness of this device for this use has not been demonstrated.
