Friday, 25 October, 2002, 10:59 GMT 11:59 UK

Electrode hope for obsessive patients

A procedure used to ease symptoms of Parkinson's disease may also help to treat
people who suffer from obsessive behaviour.

The technique involves using electrodes to stimulate a specific part of the brain
called the subthalamic nucleus.

It has been successfully used to alleviate symptoms in patients with Parkinson's

disease.

And researchers in France have found it also helped two patients who had symptoms
both of Parkinson's and Obsessive-Compulsive Disorder (OCD).

Obsessive-compulsive disorder is an anxiety disorder in which people are

persistently compelled to carry out ritualised behaviour in response to recurring
thoughts which are often completely irrational.

For instance, sufferers often become obsessed with the notion that they are
contaminated with germs, leading to hour upon hour of washing.
Common obsessions
Fear of contamination
Fear of causing harm to another
Fear of making a mistake
Fear of behaving in a socially unacceptable manner
Need for symmetry or exactness

The condition can become so bad that it prevents people from leading a normal
life.

Nerve cell circuits

The causes of the disorder, which affects at least five million Americans and a
million Britons, are still obscure.

However, it is thought to be associated with alterations to specific nerve cell

circuits in the sub-cortical regions of the brain.

One of the patients who underwent treatment had OCD symptoms characterised by
obsessive domestic cleaning and a fear of being found dead in a dirty house.

The second patient, who had battled OCD for 40 years, was preoccupied by a
checking of locks which took up to three hours a day.

Two weeks after they underwent treatment, both patients showed some improvement in
their Parkinson's symptoms.

But their compulsions had completely disappeared, and their obsessive symptoms had
also eased.
The researchers say it is possible that the improvement in OCD symptoms could
simply be explained by the improvement in Parkinson's symptoms, as people with the
disease do tend to show signs of OCD.

However, they think this is unlikely because both patients had OCD several decades
before they developed signs of Parkinson's.

They believe it is possible, but unlikely, stimulation with an electrical current

may stimulate the release of the brain chemical serotonin, which plays a
significant role in controlling mood, and is known to be found in lower levels
among OCD patients.

Alternatively, the current may inhibit electrical activity in the subthalamic

nucleus, which then has a knock-on impact on other areas of brain involved in the
control of the emotions.

Challenging condition

Researcher Professor Yves Agid, from the French Inserm institute, told BBC News
Online it was impossible to draw firm conclusions from studies on just two
patients.

But he said the technique potentially provided an alternative to more radical

forms of neurosurgery which involve burning away, or ablating, parts of the brain.

"We know that there are nerve cell circuits that a linked to control of emotions
in structures deep within the brain, and that manipulation, either through drugs
or neurosurgery, might help patients with OCD.

"Neurosurgery of this kind using electrical stimulation is reversible, adaptable

and does not induce lesions in the brain. There are almost no side effects."

Ian Hancock, director of psychology at Dumfries and Galloway Primary Care NHS
Trust, told BBC News Online that most OCD patients could be effectively treated
with cognitive behavioural therapy (CBT) techniques.

Unlike the use of implants, this is not an invasive procedure, and not does not
require the use of drugs.

He said: "If CBT and an in-patient regime has failed, and the patient is really
suffering, then - and only then - should more invasive procedures like implants
even begin to be considered.

"That would apply to a very, very small percentage of OCD patients."

The research is published in The Lancet medical journal.

See also:

04 Sep 02 | Health
Gene for obsessive behaviour
30 May 02 | Health
Religious 'vulnerable to compulsion'
20 Dec 00 | Medical notes
Obsessive-Compulsive Disorder
Internet links:
Obsessive-Compulsive Disorder
Obsessive-Compulsive Foundation
The Lancet
INSERM

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