A St. Louis neurosurgeon is helping to pioneer a new treatment for severe obsessive compulsive disorder that involves implanting a device sometimes called a “brain pacemaker.”
At first, deep brain stimulation sounds like something out of an Isaac Asimov novel. Through a hole in the skull the size of a dime, surgeons place electrodes in a patient’s brain. Wires under the skin connect the electrodes to a device similar to a cardiac pacemaker, which is implanted under the patient’s clavicle.
The device has previously been used to help control the tremors of Parkinson’s disease, but this is the first time it’s been used in the St. Louis region to target the parts of the brain responsible for severe OCD.
“The patient had some of the relief from his compulsions in the operating room,” said Dr. Richard Bucholz, who completed the surgery on a patient earlier this month at St. Louis University Hospital.
“We just saw him [Thursday], he’s doing great and he’s due to have his stimulator turned on permanently in about one week’s time,” Bucholz said.
Bucholz completed the surgery with a guiding system that he invented back in the 1980s. It’s now used by neurosurgeons worldwide.
The implant itself, called Reclaim, was approved by the Food and Drug Administration for use in OCD patients in 2009 under a humanitarian exemption. That means its target population is so small, the FDA determined that major clinical trials were unnecessary.
"The approval of the human device exemption was based on a review of data from 26 patients with severe treatment resistant OCD who were treated with the device at four sites. On average, patients had a 40 percent reduction in their symptoms after 12 months of therapy," the FDA wrote in a statement at the time.
The decision became the target of a critical article in Health Affairs that said it was a “misuse” of the FDA’s humanitarian exemption policy.
This is the first time the procedure has been attempted for an OCD patient in the St. Louis region. Because specific parts of the brain control different types of thoughts, reflexes and motor skills, treating another type of condition requires placing the electrodes in a different part of the brain.
In St. Louis, Barnes Jewish and St. Luke’s Hospitals also use deep brain stimulators to help treat Parkinson’s, essential tremor and dystonia (a neurological disorder that causes involuntary muscle contractions). Doctors have also begun using the device to treat major depression.
Dr. Mwiza Ushe, a neurologist at Barnes Jewish Hospital, said doctors there implant deep brain stimulators in patients about once or twice a week. But they’ve not yet assembled a team to complete the surgeries in people with severe OCD, which involves a different type of follow-up care.
“The thing we’ve learned from reports from patients is that they need to be followed very closely. If the devices fail for any reason they have complications, and they need a comprehensive team that follows them,” Ushe said.
For a patient to qualify for the surgery, they must have severe OCD that has not responded to other treatments. But Bucholz said he hopes that as the medical community becomes more comfortable with the treatment, the surgeries may be possible for people with less severe symptoms.
"It's my hope... that the threshold for referral for surgical intervention may significantly decrease. People may be referred earlier, before they become completely incapacitated with this disease, because it is an operation that can be performed with a fair degree of safety," Bucholz said.
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