Deep Brain Stimulation and OCD

Ihtsham ul Haq, MD
Ihtsham ul Haq, MD

Deep brain stimulation (DBS) has been shown to provide remarkable benefits in patients with Parkinson’s disease, dystonia, essential tremor and chronic pain. Today, DBS researchers continue to find new and novel ways to use the procedure to treat otherwise hard-to-manage conditions.

Ihtsham ul Haq, MD, assistant professor of neurology, is leading the way in the use of DBS to provide much needed relief for patients deeply disabled by obsessive compulsive disorder (OCD). As a fellow at the University of Florida, Haq was involved in some of the early clinical research in the use of DBS to treat OCD, and he continues that groundbreaking work today at Wake Forest Baptist.

“The people who are getting referred to DBS are deeply disabled by their disease,” said Haq. “Antidepressants haven’t worked, cognitive therapy hasn’t worked. But I’ve seen patients whose OCD was close to abolished after implantation and their lives dramatically improved.”

Clinical research into the use of DBS procedures for OCD is less than 10 years old. Until a few years ago, there were only 20 or 30 cases in the U.S. Within this minimal set of subjects, though, Haq has discovered one very interesting characteristic.

In DBS procedures conducted for OCD, there seems to be one particular indicator that the surgery is going to go well. “Sometimes people laugh when they are stimulated, sometimes they don’t,” said Haq. “According to our preliminary results the more laughter that is produced, the more likely the patient will do well in two years.”

For Parkinson’s disease and essential tremor, clinicians are able to discern success in the operating room: The lead is put in and the tremor stops in real time. With the treatment of OCD, however, there has been no guide for whether the placement was good or not.

“I think that data fits best with saying there is a particular location responsible for stimulation-induced laughter, and that understanding its function could potentially help us to do surgeries a better way,” said Haq.

Haq and colleagues have published a paper on their findings in NeuroImage and presented them at the American Academy of Neurology and the American Neurological Association. Today, they are looking to expand their research to establish the relationship between laughter and success in DBS treatment in OCD patients.

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