OCD Requiring DBS Suitability Assessment
Deep brain stimulation is for the few, and deciding who they are is a specialist task
Deep brain stimulation places fine electrodes in a precise target within the brain circuit that drives OCD and delivers continuous, adjustable stimulation from a pacemaker-like device under the skin. It is reversible, it can be tuned, and for people with the most severe and enduring OCD, those who have been through everything else, it can restore a life. I coordinated the UK's first randomised trial of DBS for OCD at the UCL Institute of Neurology between 2012 and 2016, comparing the two main targets, and I have worked on the international studies that have since mapped where in the brain stimulation works best. Deciding whether DBS is right for a particular person is the first and most important step, and it is one I do.
- Who is a candidate
- DBS is considered for severe OCD, typically a Y-BOCS score of 28 or more, and often far higher; the patients in our trial entered with an average score of 36 out of 40 and were largely housebound, that has not responded to adequate trials of at least two serotonin reuptake inhibitors and clomipramine, to augmentation, and to properly delivered exposure and response prevention, usually including intensive or inpatient treatment. The illness should have been present for years, the diagnosis secure, and the person able to take part in the programme of stimulation adjustment and therapy that follows surgery.
- What the assessment involves
- I review the entire treatment history against those criteria, confirm the diagnosis and its comorbidities, assess cognition, mood and risk, and establish that every reasonable alternative has been tried, or arrange it if it has not. Where DBS is appropriate I present the case to the multidisciplinary functional neurosurgery meeting at the National Hospital, where neurosurgeons, neurologists, neuropsychologists and I decide together, and I prepare you and your family for what the process entails. Where it is not appropriate, I say so, and set out what should happen instead.
- What DBS can achieve
- In our trial, patients who entered unable to bathe, dress, cook, shop or leave the house regained those everyday functions, self-care, housework, public transport, leisure, family life and, for some, work, over the course of stimulation. Around six in ten patients treated with DBS for OCD in published series achieve a meaningful response. My more recent work suggests that, for this extreme group, DBS is likely to be cost-saving for the health system as well as life-changing for the person. It is not a cure, and it is not for everyone; it is a treatment with a defined place, and the assessment is what defines it.
- Access
- DBS for OCD is available in the UK through a small number of specialist centres, Queen Square among them, with NHS funding by individual application. I provide suitability assessments privately and through my NHS clinic, and second opinions to psychiatrists considering referral.
Any recommendation is discussed with you in full, including benefits, risks, alternatives and the commitment involved, so that you can make an informed decision.
To arrange an assessment
Private Secretary
020 8123 0234 ·
secretary@drhimanshutyagi.com