OCD Requiring DBS Aftercare
The operation is the beginning; the aftercare is the treatment
Deep brain stimulation does not treat OCD on the day the electrodes are implanted. It treats OCD over the months and years that follow, as stimulation is adjusted, medication is reconsidered, exposure-based therapy is restarted on a brain that is now able to make use of it, and the person and their family adapt to a life the illness had closed off. That work needs a neuropsychiatrist who understands both the device and the disorder. I have followed patients through DBS for OCD since the UK's first trial, and I provide aftercare for people implanted at Queen Square and elsewhere.
- Programming and adjustment
- Stimulation settings are refined over repeated visits, guided by the response of the obsessional symptoms, mood and anxiety, and by side-effects, which can include transient elevation of mood, anxiety or, at some targets, effects on movement. Different targets act on different parts of the circuit: my trial showed that ventral capsule stimulation particularly improved mood while subthalamic stimulation particularly improved cognitive flexibility, and that knowledge shapes how I adjust the device for each person.
- Medication and therapy after DBS
- Medication is usually continued and then reviewed, not stopped on the day of surgery. More importantly, exposure and response prevention after DBS is where much of the gain is made: stimulation lowers the intensity of obsessions enough for exposure to become possible for people for whom it was previously unbearable. I direct that therapy myself or with a therapist experienced in post-DBS work.
- Long-term follow-up
- Batteries need replacing; hardware occasionally needs attention; symptoms can drift and settings can be re-optimised years later. I monitor with standardised measures, watch for relapse, and coordinate with the neurosurgical team. My current research examines very long-term outcomes after DBS for OCD, what happens a decade on, and that informs what I tell my patients to expect.
- Who I see
- People implanted at Queen Square; people implanted elsewhere in the UK or abroad who need a specialist neuropsychiatric review; and clinicians seeking a second opinion on a patient whose response to DBS has been incomplete.
To arrange an assessment
Private Secretary
020 8123 0234 ·
secretary@drhimanshutyagi.com