A recent study from Baylor College of Medicine and Texas Children’s Hospital has discovered a new brain activity pattern that can accurately predict and monitor the status of people with obsessive-compulsive disorder (OCD) who have undergone deep brain stimulation (DBS).
This finding is a significant advancement for treating severe psychiatric disorders.
The research, led by Drs. Sameer Sheth and Wayne Goodman, along with others, was published in Nature Medicine. Dr. Provenza, an assistant professor at Baylor College of Medicine, highlighted that advancements in surgical neuromodulation now allow continuous monitoring of brain activity in OCD patients during their daily lives.
This opportunity led the team to identify crucial brain patterns that predict the clinical state of 12 individuals with severe OCD undergoing DBS therapy.
OCD is a common and severe mental health condition affecting 2-3% of the global population, including about two million people in the U.S. In extreme cases, individuals spend excessive amounts of time on repetitive behaviors and intrusive thoughts, significantly affecting their quality of life and ability to maintain jobs and relationships.
While psychotherapy and medications help many, 20-40% of those with severe OCD do not respond to these treatments.
Since the early 2000s, DBS has been used to modulate brain activity in specific areas linked to OCD symptoms. Many patients eligible for DBS have not benefited enough from standard therapies.
For those with treatment-resistant OCD, approximately two-thirds show significant improvement after DBS. DBS works similarly to a heart pacemaker, sending electrical impulses to the brain to regulate its activity and restore normal function.
DBS is FDA-approved for movement disorders like Parkinson’s disease and essential tremors and is increasingly used for severe OCD.
Dr. John Ngai, Director of the BRAIN Initiative at the National Institutes of Health, noted that this study is part of ongoing progress in DBS research, bringing treatments for OCD closer to clinical use.
One major challenge with DBS for psychiatric disorders like OCD is determining the correct dose of stimulation. For movement disorders, correct stimulation is evident through immediate physical improvements, such as reduced tremors.
However, for OCD, the effects of DBS take longer to appear, making it hard to pinpoint what adjustments lead to symptom improvement.
Dr. Sheth emphasized the need for a reliable brain activity marker to guide DBS management and remotely monitor patients’ symptoms. This is crucial as many patients travel long distances for DBS treatment, available only in a few specialized centers.
To find an optimal target for a biomarker, the team focused on the hallmark OCD behavior of pathological avoidance. OCD sufferers often avoid potential harm or distress, leading to intrusive thoughts and repetitive actions.
The researchers studied how specific brain waves (4-12 Hz) linked to cognitive processes changed in patients with severe OCD. They utilized modern DBS devices capable of both stimulating and recording brain activity.
Unlike typical studies with brief, task-based brain monitoring, this research continuously recorded brain activity during everyday activities. This approach provided a more natural view of the participants’ brain function.
Upon DBS implantation, the team measured brain activity before stimulation began, capturing patterns during severe symptoms. They found a predictable 9 Hz brain wave pattern fluctuating over 24 hours.
After DBS activation, as patients improved, this pattern became less predictable. Dr. Goodman explained that OCD sufferers often stick to repetitive routines, resulting in highly predictable brain activity.
Improved patients showed more flexible behaviors and varied brain activity, indicating fewer compulsive behaviors.
Dr. Sheth noted that the identified brain activity pattern could reliably indicate mood and behavior improvements in OCD patients after DBS. This discovery could revolutionize patient monitoring during DBS therapy.
Incorporating this information into a clinical dashboard could simplify DBS programming, making the therapy more accessible. Dr. Provenza suggested that similar brain activity patterns might be found in other neuropsychiatric disorders, potentially serving as biomarkers for these conditions.
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The research findings can be found in Nature Medicine.
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