*September 14, 2010*

NEW DELHI: In a rare first for Asia, Obsessive Compulsive Disorder (OCD) --
a medical condition that results in repetitive behaviour such as
handwashing, counting, checking or cleaning -- has been treated with a
pacemaker fitted in parts of the brain.
A team from VIMHANS in the capital has successfully implanted a pacemaker in
the brain of an OCD patient, which has "significantly reduced her
peculiarities in just two weeks time".

The team, including neurosurgeons Dr Alok Gupta and Dr Sanjeev Kumar and
psychiatrist Dr Ashutosh Tripathi, used Deep Brain Stimulation (DBS) to
implant the pacemaker for sending electrical impulses to specific parts of
the brain.

DBS, which has been used in select brain regions till now, has provided
remarkable therapeutic benefits for disorders like such as Parkinson's and
dystonia. However, it has been used for the first time to treat OCD.

" DBS involves precise stimulation of particular parts of the brain through
the implantation of removable electrodes. Two electrodes have been wired to
both sides of patient's brain (anterior limb of internal capsule) which
communicate through the pacemaker, the battery of which has been put inside
her chest. We can alter the function of any part of the brain by stimulating
it. If stimulated with low frequency electrodes, the area starts to get
excited. With high frequency, it blocks off the pathway and reduces
symptoms. In her case, we used high frequency electrodes to block the
pathway of the brain that was causing OCD," Dr Gupta explained.

The 48-year female patient had been suffering from OCD for the past 21
years.She had been living in constant fear of all kinds of touch, scared
that any contact with her children or object would severely soil her hands.

Her condition had become so acute that she stopped eating or going to the
toilet on her own. In fact, she would sit all day on the bed without
touching anything, waiting for her children or husband to feed her or take
her to the toilet.

To make matters worse, if she touched anything by mistake, she would wash it
several times. Strangely, she would not turn off the tap even after using
it.

"Two weeks since the implant, she has not just started eating on her own but
is now completely independent," Dr Gupta added.

Though there are a number of medications and psychological therapies
available to treat OCD, it is estimated that about 10% patients don't
respond adequately to these first-line interventions.

"DBS is for those patients who don't respond to medication. Psychiatrists
need to identify these patients before the brain pacemaker could be used.
Besides, the price of this form of treatment is yet to be determined. DBS
used for Parkinson's patients costs $8000 in India," Dr Gupta said.

DBS has several advantages over traditional brain surgery for OCD. It can be
used to treat symptoms with little risk of permanent changes in the brain.
The level of stimulation can be adjusted, and the stimulation can be used
continuously or intermittently depending on the treatment plan.

Since the surgery is minimally invasive, it has a reduced potential for side
effects.

*
http://timesofindia.indiatimes.com/india/In-a-first-pacemaker-fitted-in-brain-helps-cure-OCD/articleshow/6555082.cms
*

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