Deep Brain Stimulation

Future Therapies

With the advent of new functional neuroimaging techniques such as PET, SPECT, and fMRI, researchers have been able to photograph and learn more about the crucial brian regions involved in producing the symptoms of OCD. With the new knowledge, researchers have developed new therapies which could shape the future of OCD. Thus, the future of OCD therapy is in the hands of the companies doing clinical trials on new methods. Here are a couple of other therapies that could replace current ones.

*Magnetic Stimulation Therapy (MST)*	- This form of therapy would be preferable to DBS or other electrical methods of therapy. Magnetic fields pass through the skull and soft tissue unimpeded. As a result, the therapy can be applied in a much more focused fashion using a much less invasive method. - MST would still require general anesthesia. - It is unknown whether a generalized convulsion rather than constant stimulation or ablation is important for the treatment of OCD. - It is unclear whether or not OCD requires constant or episodic (MST) treatment. - MST has not been performed in humans yet (11).
Transcranial Magnetic Stimulation (TMS)	- A different method of non-invasively modifying regional brain activity. - Uses a powerful hand-held magnet to create a time-varying magnetic field. - Creates electrical currents in a superficial cortex, a form of "electrodeless" electrical stimulation. - TMS for OCD has been tested on humans. - TMS is the most promising future therapy (11).
Vagus Nerve Stimulation (VNS)		- FDA has approved VNS for the treatment of epilepsy. - About 7,000 people worldwide have these generators implanted in them. - VNS as a therapy for OCD is debatable. If VNS actions were limited to locus ceuleus and norepinephrine effects, then current thinking would predict only minimal effect of VNS on OCD symptoms. Yet, studies have shown that VNS has effects on serotonin systems and thus a trial of VNS for OCD appears warranted.

Magnetic Stimulation Therapy (MST)

- This form of therapy would be preferable to DBS or other electrical methods of therapy. Magnetic fields pass through the skull and soft tissue unimpeded. As a result, the therapy can be applied in a much more focused fashion using a much less invasive method.

- MST would still require general anesthesia.

- It is unknown whether a generalized convulsion rather than constant stimulation or ablation is important for the treatment of OCD.

- It is unclear whether or not OCD requires constant or episodic (MST) treatment.

- MST has not been performed in humans yet (11).

Transcranial Magnetic Stimulation (TMS)

- A different method of non-invasively modifying regional brain activity.

- Uses a powerful hand-held magnet to create a time-varying magnetic field.

- Creates electrical currents in a superficial cortex, a form of "electrodeless" electrical stimulation.

- TMS for OCD has been tested on humans.

- TMS is the most promising future therapy (11).

Vagus Nerve Stimulation (VNS)

- FDA has approved VNS for the treatment of epilepsy.

- About 7,000 people worldwide have these generators implanted in them.

- VNS as a therapy for OCD is debatable. If VNS actions were limited to locus ceuleus and norepinephrine effects, then current thinking would predict only minimal effect of VNS on OCD symptoms. Yet, studies have shown that VNS has effects on serotonin systems and thus a trial of VNS for OCD appears warranted.

The future therapy for patients afflicted with refractory OCD will be with magnetic/electric stimulation. With further testing and investigation of groups such as the ones led by Dr. Greenberg, these developing technologies could help many people.