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Local Doctor Pioneers Obsessive-Compulsive Disorder Approach

Thursday, March 03, 2011

 

At the recent annual meeting of the American Association for the Advancement of Science, Benjamin Greenberg, M.D., a psychiatrist at Brown University and at Butler Hospital, discussed the longest-term results of delivering an electrical current to a cord of the brain’s wiring and softening the severity of obsessive-compulsive disorder (OCD) by inserting a thin electrode deep into the brain. “Deep brain stimulation” therapy for OCD won Food and Drug Administration approval in 2009 for extreme cases under its humanitarian device exemption. Encouraged as he is with the progress, Greenberg addressed how to best apply it, and how basic and clinical researchers are working to understand the changes in brain networks and behaviors that occur when patients improve.

Proceeding With Caution

“These techniques are promising but must be used with an abundance of caution,” said Greenberg, associate professor of psychiatry and human behavior at the Warren Alpert Medical School and chief of outpatient services at Butler Hospital. “This is reserved for the small proportion of people who are severely disabled and have not benefitted anywhere near adequately from very aggressive use of conventional treatments.” Just over 50 patients have had DBS for OCD in the United States since the work began in 2000. Although OCD affects about 1 percent of the adult population in a given year, only a small subset of patients might be eligible for DBS. To qualify, they must have very severe and chronically disabling illness despite at least five years of aggressive treatment by experts.

New Findings

The newest results, presented in Greenberg’s AAAS talk, showed that the patients who improve initially and continue to receive stimulation generally remain improved for eight or more years of follow-up. “What DBS really does is make you into an average OCD patient,” Greenberg said. For nearly four years, the research at Brown and Butler, including work at the Conte Center for OCD based at the University of Rochester (where Greenberg is the co-primary investigator) was been funded exclusively by the National Institute of Mental Health (NIMH). NARSAD and Medtronic provided funding for the pilot clinical work. Greenberg received a past honorarium from Medtronic, for which he has also consulted, with proceeds paid to Butler Hospital.
 

 

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