Deep brain stimulation improves OCD symptoms, promotes smoking cessation and weight loss

Electrical stimulation of the brain in a patient with severe obsessive-compulsive disorder (OCD) led to some unanticipated benefits—"effortless" smoking cessation and weight loss, according to a case report in the September issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health, a leading provider of information and business intelligence for students, professionals, and institutions in medicine, nursing, allied health, and pharmacy.

The experience may offer clues into the "reward brain circuitry" involved not only in OCD, but also in other compulsive disorders like smoking and overeating. With further research, deep brain stimulation "could be a possible treatment of patients with a dependency not responding to currently available treatments," according to the report by Dr. Daamian Denys of Academic Medical Centre, Amsterdam, and colleagues.

Deep Brain Stimulation Improved OCD Symptoms…
The patient was a 47-year-old woman who had extremely severe OCD related to fear of dirt and excessive cleaning. In addition to OCD, the patient was a heavy smoker, nearly two packs per day; and was severely obese, with a weight of 235 pounds (body mass index 37). When medications did not improve the patient's disabling OCD symptoms, an alternative treatment was recommended: deep brain stimulation.

The patient underwent placement of electrodes in a brain area called the nucleus accumbens, which has been found to be involved in OCD and other addictive disorders. The electrodes were then connected to a small generator, which was programmed to deliver electrical stimulation to the brain. Now commonly used in conditions like Parkinson's disease, deep brain stimulation has emerged as a new option for patients with severe OCD that do not respond to other treatments.

With electrical stimulation therapy, the patient's OCD symptoms gradually improved. Improvement peaked after ten months—the time she spent on her compulsions and obsessions decreased from 20 hours to 1 hour per day, and the patient no longer felt she was impaired by OCD in her daily life.

…With 'Effortless' Smoking Cessation and Weight Loss
"At this moment," the researchers write, "she realized that she was not dependent on her compulsions anymore, but that she was still dependent on her cigarettes." After noticing that non-smokers looked "healthier and more relaxed than smokers," the patient decided to quit smoking—and the next day, she did so. She had no cravings and no withdrawal symptoms, even though her husband continued to smoke. (When she eventually convinced him to quit, he experienced "serious" withdrawal.)

Two weeks later, the patient decided to lose weight as well. She changed her diet with the help of a dietitian and began to lose weight steadily. Soon afterward, she began an exercise program. By 10 months, she had achieved her weight loss goal of nearly 100 pounds (body mass index 25). Two years later, she had kept the weight off and was still not smoking. Her OCD symptoms also stayed under control.

The changes were not immediate, but after the OCD symptoms disappeared, the patient "reported having tranquility in her head for the first time in many years," Dr. Denys and colleagues write. "This gave her the possibility to stop her compulsions and subsequently to think about other habits she wanted to change." Once she made the decision to stop smoking and overeating, "she banished them both effortlessly from her life."

Although it's just one case, the results are consistent with research showing that compulsive behaviors are related to the brain reward system, which involves the nucleus accumbens. The "hyperactive" responses observed in these areas of the brain in patients with OCD are similar to those elicited by smoking, overeating, and compulsive drug use.

"Together these findings suggest that deep brain stimulation DBS of the nucleus accumbens might be able to suppress symptoms of various disorders in which the pathophysiology involves the brain reward circuitry, of which the nucleus accumbens is a critical relay station," the researchers write. However, more research will be needed to confirm these preliminary results, and to understand how deep brain stimulation works to relieve OCD symptoms and other compulsive behaviors.