Deep Brain Stimulation for Obsessive-Compulsive Disorder

Overseen By Tash Mupambo

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Nader Pouratian

Must be taking: Serotonin transport inhibitors

Disqualifiers: Severe MDD, Psychotic disorder, PTSD, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 3 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 9

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether deep brain stimulation (DBS) can help individuals with severe, treatment-resistant obsessive-compulsive disorder (OCD). Researchers aim to determine if DBS reduces OCD symptoms by comparing it to a placebo (a fake treatment). Participants will have a device implanted in their brain and attend regular follow-up visits. This trial suits those who have experienced severe OCD for more than five years without improvement from typical treatments or therapy. As an unphased trial, it offers patients the opportunity to explore a cutting-edge treatment option that could potentially improve their quality of life.

Do I need to stop my current medications for this trial?

The trial protocol does not specify if you need to stop your current medications. However, since the trial involves deep brain stimulation for severe OCD that hasn't improved with medication, it's possible you may continue your current treatment. Please consult with the study team for specific guidance.

What prior data suggests that deep brain stimulation is safe for treating obsessive-compulsive disorder?

Research has shown that deep brain stimulation (DBS) is generally safe for treating severe obsessive-compulsive disorder (OCD). Studies have found it effective, with side effects that are usually mild. While some side effects can occur, they are not often serious.

DBS has been used successfully in other studies for treating OCD, with many participants experiencing improvements in their symptoms. Side effects can happen, but they are often minor and manageable. Some individuals might experience mood changes or headaches, but these are typically not serious.

Overall, DBS is considered well-tolerated for treating OCD. Extensive studies have provided reassuring safety data for those considering this option. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Deep Brain Stimulation (DBS) for Obsessive-Compulsive Disorder (OCD) because it offers a novel approach compared to standard treatments like cognitive-behavioral therapy (CBT) and medications such as SSRIs. Unlike these conventional methods, DBS involves implanting electrodes in specific brain regions to directly modulate neural activity. This direct brain intervention could potentially provide relief for patients who don't respond to typical therapies. Additionally, DBS allows for customizable and potentially reversible treatment adjustments, making it a promising option for managing severe OCD symptoms.

What evidence suggests that deep brain stimulation might be an effective treatment for OCD?

Research has shown that deep brain stimulation (DBS) can help treat severe obsessive-compulsive disorder (OCD). Approximately 60% of patients receiving this treatment experience a reduction of more than 35% in their OCD symptoms, according to a standard measurement tool. The trial includes different arms where participants receive either therapeutic stimulation or sham control stimulation before transitioning to an open-label phase. Improvement often increases over time, with long-term studies showing even more positive results. DBS proves especially useful for individuals whose OCD does not improve with other treatments, providing relief from both OCD symptoms and related depression. Overall, DBS is a promising option for those with hard-to-treat OCD. ^{1 5 6 7 8}

Who Is on the Research Team?

Nader Pouratian

Principal Investigator

University of Texas Southwestern Medical Center

Are You a Good Fit for This Trial?

This trial is for individuals with severe Obsessive-Compulsive Disorder (OCD) that hasn't improved with standard treatments. Participants will undergo surgery to implant a deep brain stimulation device and must commit to follow-up visits every three weeks, plus long-term check-ups for 2-3 years after the first year.

Inclusion Criteria

I am between 22 and 75 years old.

Severe OCD assessed by the Yale-Brown Obsessive-Compulsive Scale (YBOCS) with a score of more than 27

I have been diagnosed with obsessive-compulsive disorder.

Exclusion Criteria

Significant suicidal risk (Hamilton Depression scale item 3 (suicide) >2)

History of substance or alcohol dependence or abuse in the preceding 12 months

I have a primary psychotic disorder, PTSD, or an eating disorder.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Surgery and Initial Treatment

Participants undergo surgery for the implantation of a deep brain stimulation device and begin initial treatment phase

16 weeks

Intra-operative recordings and initial follow-up visits

Cross-over Treatment

Participants are randomized to either sham or therapeutic stimulation for 16 weeks, then cross-over to the other condition

32 weeks

Formal psychiatric assessments every 3 weeks

Open-label Extension

All participants transition to an open-label stimulation phase for chronic therapy

Long-term

Assessments every 6 weeks

Follow-up

Participants are monitored for safety and effectiveness after treatment

6 months for 2-3 years

Follow-up visits every three weeks

What Are the Treatments Tested in This Trial?

Interventions

• Deep Brain Stimulation

Trial Overview The study tests if activating certain brain areas with Medtronic Percept Deep Brain Stimulation Therapy improves OCD symptoms compared to sham (fake) stimulation. It also involves mapping brain activity related to symptom severity during and after surgery.

How Is the Trial Designed?

Group I: Therapeutic stimulation, then Sham Control stimulation Experimental Treatment 2 Interventions

Subjects randomized to this arm are initially "ON" DBS prior to the open label period for 16 weeks and then "OFF" DBS for the next 16 weeks. This is followed by an open-label stimulation period.

Group II: Therapeutic stimulation Experimental Treatment 1 Intervention

All participants will transition to an open label stimulation phase for chronic therapy after the cross-over portion of this trial

Group III: Sham Control stimulation, then Therapeutic stimulation Experimental Treatment 2 Interventions

Subject randomized to this arm are initially "OFF" DBS (Deep Brain Stimulation) prior to the open label period for 16 weeks and then "ON" DBS for the next 16 weeks. This is then followed by an open-label period of DBS stimulation.

Deep Brain Stimulation is already approved in United States, European Union, Canada for the following indications:

Approved in United States as Deep Brain Stimulation for:

• Essential tremor
• Parkinson's disease
• Dystonia
• Obsessive-compulsive disorder
• Epilepsy
• Chronic pain
• Stroke-related motor deficits (under investigation)

Approved in European Union as Deep Brain Stimulation for:

• Essential tremor
• Parkinson's disease
• Dystonia
• Obsessive-compulsive disorder
• Epilepsy
• Chronic pain

Approved in Canada as Deep Brain Stimulation for:

• Essential tremor
• Parkinson's disease
• Dystonia
• Obsessive-compulsive disorder
• Epilepsy
• Chronic pain

Who Is Running the Clinical Trial?

Nader Pouratian

Lead Sponsor

Trials

4

Recruited

20+

Published Research Related to This Trial

Deep brain stimulation (DBS) has been effectively used for treating severe, refractory obsessive-compulsive disorder (OCD), building on decades of experience with neurosurgical interventions.

The therapy received Humanitarian Device Exemption (HDE) approval from the FDA in 2009 due to promising results, indicating its potential as a viable treatment option for patients with OCD who do not respond to conventional therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deep brain stimulation for obsessive-compulsive disorder. Arya, S., Filkowski, MM., Nanda, P., et al.[2019]

In a study of 21 patients with severe OCD or MDD undergoing deep brain stimulation (DBS) in the ventral striatum, no significant cognitive declines were observed after an average of 8.91 months of stimulation.

Patients showed significant improvements in verbal memory, suggesting that DBS may enhance cognitive functions without negatively impacting overall mental health, although further research is needed to confirm these findings.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Neuropsychological outcome after deep brain stimulation in the ventral capsule/ventral striatum for highly refractory obsessive-compulsive disorder or major depression. Kubu, CS., Malone, DA., Chelune, G., et al.[2013]

Deep brain stimulation (DBS) for severe treatment-refractory obsessive-compulsive disorder (OCD) showed a significant long-term reduction in OCD symptoms by 39% over an average follow-up of 6.8 years, with half of the patients experiencing a substantial response.

DBS also led to significant improvements in anxiety and depression symptoms, quality of life, and overall functioning, while the unemployment rate decreased from 78% to 58%, indicating enhanced well-being despite some long-term adverse effects like cognitive complaints and fatigue.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Long-term Outcome of Deep Brain Stimulation of the Ventral Part of the Anterior Limb of the Internal Capsule in a Cohort of 50 Patients With Treatment-Refractory Obsessive-Compulsive Disorder. Graat, I., Mocking, R., Figee, M., et al.[2021]

Deep brain stimulation (DBS) is a novel treatment for severe obsessive-compulsive disorder (OCD) that directly modulates brain activity, offering a different mechanism of action compared to traditional therapies like medication and psychotherapy.

The effectiveness of DBS is evaluated through an interactive process between clinicians and patients, where improvements are seen as increased patient engagement and openness to therapeutic activities, suggesting that DBS can enhance the potential for additional cognitive behavioral therapy (CBT).

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effective Deep Brain Stimulation for Obsessive-Compulsive Disorder Requires Clinical Expertise. van Westen, M., Rietveld, E., Denys, D.[2023]

Deep brain stimulation (DBS) in the bed nucleus of stria terminalis (BNST) showed a significant response in 60% of the 10 patients with severe, treatment-resistant OCD, with an average symptom reduction of 53% as measured by the YBOCS scale.

The treatment not only reduced OCD symptoms but also improved depressive symptoms, global functioning, and quality of life, indicating that DBS could be a promising option for patients who do not respond to standard therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deep brain stimulation for treatment resistant obsessive compulsive disorder; an observational study with ten patients under real-life conditions. Abdelnaim, MA., Lang-Hambauer, V., Hebel, T., et al.[2023]

Deep brain stimulation (DBS) for treatment-resistant obsessive-compulsive disorder (OCD) has been associated with various adverse events, with psychiatric issues being the most common (40%), followed by neurological problems (19%) and infections (10%).

The study highlights that while DBS may be a viable treatment option for certain patients with refractory OCD, ongoing monitoring and further research are necessary to fully understand the long-term safety and efficacy of this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deep brain stimulation for refractory obsessive-compulsive disorder: A review and analysis of the FDA MAUDE database. Porwal, MH., Karra, H., Sharma, U., et al.[2022]

Deep Brain Stimulation (DBS) for Parkinson's disease can lead to rare complications, such as an intracranial abscess, as demonstrated in a case involving a 59-year-old male who developed significant inflammation and required multiple surgeries after the procedure.

Despite the complications, the patient's Parkinson's symptoms improved after the abscess was surgically drained, suggesting that the abscess may have inadvertently provided some therapeutic benefit similar to a subthalomotomy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intracerebral abscess: a rare complication of Deep Brain Stimulation. Brandão, E., Rosas, MJ., Abreu, P., et al.[2013]

In a pilot study involving six patients with severe, treatment-resistant OCD, 66.7% showed significant improvement after 12 months of deep brain stimulation (DBS) targeting the ventral capsule/ventral striatum, indicating its potential as a last-resort therapy.

The study reported that while DBS led to improvements in OCD symptoms and global functioning, some patients experienced mild adverse effects, and stimulation interruption could quickly induce depressive symptoms, highlighting the need for careful patient management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Goodman, WK., Foote, KD., Greenberg, BD., et al.[2022]

In a study of 30 patients with severe, treatment-refractory OCD, deep brain stimulation (DBS) showed a 42% reduction in obsessive-compulsive symptoms after 12 months, with a responder rate of 60%.

While all patients experienced adverse events (195 total), most were mild or moderate, and the serious adverse events were primarily transient anxiety and worsening of affective symptoms, suggesting that the benefits of DBS may outweigh the risks in this challenging patient population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A prospective international multi-center study on safety and efficacy of deep brain stimulation for resistant obsessive-compulsive disorder. Menchón, JM., Real, E., Alonso, P., et al.[2022]

Deep brain stimulation (DBS) shows promise as a safe and effective treatment for patients with treatment-resistant obsessive-compulsive disorder (OCD), with average reductions in Yale-Brown Obsessive Compulsive Scale scores ranging from 6.8 to 31 points across small studies.

Approximately 50% of patients respond positively to DBS, and the frequency of adverse events appears to be limited, indicating that it could be a viable option for those who do not respond to traditional therapies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Current status of deep brain stimulation for obsessive-compulsive disorder: a clinical review of different targets. de Koning, PP., Figee, M., van den Munckhof, P., et al.[2021]

Deep brain stimulation (DBS) can lead to significant psychiatric side effects, particularly when electrodes are implanted in the subthalamic nucleus, which is associated with increased risks of depression and suicidal thoughts.

Higher voltage settings during DBS are linked to more severe depressive symptoms, highlighting the need for careful management of stimulation parameters to minimize adverse effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Stimulation-induced side effects after deep brain stimulation - a systematic review. Zarzycki, MZ., Domitrz, I.[2022]

Deep brain stimulation (DBS) of the subthalamic nucleus can significantly reduce the severity of symptoms in patients with severe and persistent Obsessive Compulsive Disorder (OCD), especially in those who do not respond to traditional treatments.

DBS not only helps alleviate OCD symptoms but also enhances overall functioning, providing insights into the underlying mechanisms of the disorder.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[OCD: when limbic systems start looping...]. Flores Alves dos Santos, J., Mallet, L.[2013]

In a study of 16 OCD patients who underwent deep brain stimulation (DBS) for at least one year, stopping DBS for just one week led to a significant increase in obsessive-compulsive symptoms, anxiety, and depression, with scores rising by 50%, 80%, and 83% respectively.

The cessation of DBS also resulted in a noticeable decline in quality of life, reverting to levels similar to those before surgery, indicating that stopping DBS can lead to a rapid relapse and rebound of psychiatric symptoms.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Rebound of affective symptoms following acute cessation of deep brain stimulation in obsessive-compulsive disorder. Ooms, P., Blankers, M., Figee, M., et al.[2018]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8474989/

Deep brain stimulation for obsessive-compulsive disorder The percentage of responders increased from 60.6% in the ST studies to 70.7% in the LT studies, indicating that DBS provided effective therapy for severe ...

2. sciencedirect.com sciencedirect.com/science/article/pii/S1935861X2200170X

Long-term comparative effectiveness of deep brain ... The meta-analyses carried out to date indicate that 60% of patients achieve a reduction of more than 35% in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) ...

3. jnnp.bmj.com jnnp.bmj.com/content/93/11/1166

Efficacy of deep brain stimulation for treatment-resistant ... A strong evidence base supports DBS for TROCD in relieving both OCD and comorbid depression symptoms in appropriately selected patients.

4. thejns.org thejns.org/caselessons/view/journals/j-neurosurg-case-lessons/8/18/article-CASE24289.xml

Effective deep brain stimulation for obsessive-compulsive ... Both patients showed significant improvement (≥ 35% reduction in Yale-Brown Obsessive-Compulsive Scale [YBOCS] score) of their OCD symptoms at ...

5. frontiersin.org frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.568932/full

Deep Brain Stimulation for Obsessive-Compulsive Disorder DBS remains an efficacious tool for the treatment of OCD, even in patients with significant comorbidities in whom DBS has not previously been investigated.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10952286/

Clinical outcomes of deep brain stimulation for obsessive‐ ... Six participants achieved clinical response (35% improvement in obsessions and compulsions on the Yale Brown Obsessive Compulsive Scale (YBOCS)) within 6–9 ...

7. sciencedirect.com sciencedirect.com/science/article/pii/S1094715921000787

Optimizing Deep Brain Stimulation Parameters in ... This article focuses on DBS stimulation parameter optimization. DBS optimization means maximizing treatment efficacy and minimizing side effects.

8. psychiatrist.com psychiatrist.com/jcp/deep-brain-stimulation-in-refractory-ocd/

Efficacy, Effect on Mood Symptoms, and Safety of Deep ... Our results showed that, including recent trials performed, DBS can significantly decrease YBOCS score and depressive symptoms in refractory OCD ...