{"id":28248,"date":"2019-12-19T12:09:36","date_gmt":"2019-12-19T19:09:36","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=28248"},"modified":"2023-09-28T16:36:26","modified_gmt":"2023-09-28T22:36:26","slug":"deep-brain-stimulation-for-ocd","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/deep-brain-stimulation-for-ocd\/","title":{"rendered":"Deep brain stimulation zaps OCD, opens new path for young patient"},"content":{"rendered":"
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He washed his hands until it looked like they\u2019d been in a fight. He couldn\u2019t stand the presence of fast food. He found anything with connotations to the southern United States entirely repulsive. Jon Blank knew none of this made sense. But his obsessions and compulsions, exhausting and extreme to the point that his voice had eroded to a listless monotone and he could no longer hold down a job or focus on school, were a product of something deeper, driven by forces beyond his control. His obsessive-compulsive disorder had swamped the ability of standard treatments to provide relief.<\/p>\n

\"Jon
Jon Blank, who suffered from severe obsessive-compulsive disorder, got his life back after having deep brain stimulation for OCD at UCHealth. Photo by John Johnson for UCHealth.<\/figcaption><\/figure>\n

Blank\u2019s care team at UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> (UCH) told him one option remained: deep brain stimulation, or DBS. If he had the surgery, his odds for a turnaround would be about 50-50. Less certain was whether outside factors would let him into the operating room in the first place.<\/p>\n

Deep brain stimulation for OCD<\/h3>\n

Deep brain stimulation has been a U.S. Food and Drug Administration-approved therapy to help patients with essential tremor<\/a> since 1997, Parkinson\u2019s disease<\/a> since 2002, and dystonia since 2003. Tens of thousands of patients with these movement disorders have undergone the procedure, which places electrodes deep in the brain and, in follow-on surgeries, implants batteries to supply an adjustable amount of electrical stimulation to those electrodes.<\/p>\n

In 2009, the FDA approved deep brain stimulation for obsessive-compulsive disorder (OCD) that’s severe to extreme, which isn\u2019t a movement disorder. The approval hinged on an FDA Humanitarian Device exemption<\/a>, which applies to treatments for diseases rare enough that it\u2019s difficult to impossible to enroll enough patients to run effective clinical trials. While OCD diagnoses are common \u2013 about one in 40<\/a> people will experience it at some point \u2013 its severest forms are rare. The exemption \u2013 rather than full FDA approval \u2013 has led to high hurdles for deep brain stimulation for OCD patients.<\/p>\n

\"Jon
Jon Blank snowboards near Loveland Pass. He had deep brain stimulation to help with obsessive-compulsive disorder. Photo by John Johnson for UCHealth.<\/figcaption><\/figure>\n

The first DBS surgery was on a UCH patient in 2015. To do so, physicians had to demonstrate to the hospital\u2019s Institutional Review Board<\/a> that DBS has been shown to be safe as well as effective for OCD patients \u2013 normally, the board vets clinical trials, not proven procedures. Each year, doctors have repeated the process, showing outcomes, listing complications, and referring to new literature on DBS for OCD patients.<\/p>\n

Also standing between Blank and the operating room was the requirement that the patient have severe to extreme OCD \u2013 but not oft-associated diagnoses such as bipolar disorder, substance use, or severe personality disorder.<\/p>\n

Those who clear that checkpoint must have exhausted other proven treatments, which include serotonin-boosting drugs, an antipsychotic, a benzodiazepine, and cognitive behavioral therapy with exposure and response prevention therapy (ERP<\/a>).<\/p>\n

And finally, there was the question of insurance. Despite the FDA Humanitarian Device-exception approval, many insurance plans still classify DBS for OCD as investigational and won\u2019t pay for treatments. Patients with severe OCD who are old enough to be off their parents\u2019 insurance \u2013 Blank was 28 \u2013 are often on Medicaid, which covered it for Blank.<\/p>\n

\"snowboarder
Jon Blank near Loveland Pass. Photo by John Johnson for UCHealth.<\/figcaption><\/figure>\n

Blank proved to be among the few who have made it through the gauntlet. In January and February 2018, Blank had three surgeries: placing electrodes on the left and right sides of Blank\u2019s brain, inserting battery packs on either side of his upper chest, and connect the wires. On Feb. 22, 2018, Dr. Rachel Davis activated and programmed the device in a CU School of Medicine clinic room.<\/p>\n