Wednesday, December 12, 2018

Deep Brain Stimulation: An Ambiguous Breakthrough


Obsessive-compulsive disorder (OCD) is a psychiatric disorder affecting approximately 2% of the population. It is characterized by thoughts that are both equally as obsessive as they are intrusive, which generate anxiety. Such thoughts are then followed by compulsions with the function of neutralizing the distress, which is caused by the intrusive thoughts. OCD is among the most disabling psychiatric disorders, and there’s a significantly high mortality rate associated with the disorder. There is also research that indicates 10–27% of the patients may attempt suicide sometime during their lifetime. (Naesström et al., 2017)

Matilda Naesström and a team of researchers examine both the basis of knowledge and concerns regarding deep brain stimulation with respects to treating OCD in, “Deep Brain Stimulation for Obsessive-Compulsive Disorder: Knowledge and Concerns among Psychiatrists, Psychotherapists and Patients.” Naesström conducted an online survey, which was intended to target specific professional groups, i.e. patients, psychiatrists, and cognitive behavioral therapists. The survey asked questions that meant to determine the magnitude of prior knowledge in the treatment method of deep brain stimulation, as well as determining reasons for concern, if any with respects to the treatment. They found that the primary source of information for professionals was from scientific sources, i.e. contemporary research, professional colleagues, etc. Oppositely, patients indicated that their primary source of information was the media, which itself is cause for concern given that the media sensationalizes popular psychology. That aside, the survey found that common areas of concern within both groups include: surgical complications, side effects--specifically personality changes, and anesthetic complications.

The paper, “Neuron matters: electric activation of neuronal tissue is dependent on the interaction between the neuron and the electric field,” notes that neurons are able to be activated by using electromagnetic induction methods. The objective of the research was to explain the transmembrane electric field and its induced transmembrane potential with respects to external electric stimulation. Dr. Hui Ye explains that in deep brain stimulation, “alternating currents applied via transcranial alternating current stimulation (tACS) over the occipital cortex of the brain can entrain neural oscillations of the underlying brain,” (Ye & Steiger, 2015). It also details that within lab research, direct current (DC) electric stimulation indicates suppression of in vitro seizure activity (Ye & Steiger, 2015). Given such results, it is suspected that deep brain stimulation can be used to treat other neurological and psychiatric illnesses; however, there’s still great cause for concern in this method in a variety of areas.

Dr. Ye’s research does prove to be a significant breakthrough in treating neurological and psychiatric. However, it becomes imperative for all medical professionals to understand the perils of generalization in treatment. Although suppression of seizure activity could be seen, it still become unclear if deep brain stimulation can be used “across the board” to treat other disorders, of which are different in how they impair neurological functions. Naesström’s research indicates the skepticism behind this treatment method specifically with respect to OCD, as well as demonstrating there is still much to observe about it in both perspectives of patients and psychiatric/neurological professionals. Additionally, her research shows how much more professionals need to advocate for education of specialized treatments, such as deep brain stimulation, in order to properly clarify what is meant to happen and what could happen as a result to patients that choose to consider it.

To conclude, challenges exist for deep brain stimulation in OCD, which was indicated by participants of Naesström’s research. The challenges being: sources of information, potential negative side effects, and whether or not patients are eligible. Within those given criteria, the current evidence foundation still is limited, and a vast research agenda is still required for research going forward.

References
Ye, H, and A Steiger. “Neuron Matters: Electric Activation of Neuronal Tissue Is
Dependent on the Interaction between the Neuron and the Electric Field.” Current
Neurology and Neuroscience Reports., U.S. National Library of Medicine, 12 Aug.
2015, www.ncbi.nlm.nih.gov/pubmed/26265444.
Naesström, Matilda, et al. “Deep Brain Stimulation for Obsessive-Compulsive Disorder:
Knowledge and Concerns among Psychiatrists, Psychotherapists and Patients.” National
Center for Biotechnology Information, US National Library of Medicine, 6 Dec. 2017,
www.ncbi.nlm.nih.gov/pmc/articles/PMC5735431/.



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