Researchers from the University of Utah Health (U of U Health) psychiatric-neurosurgical center at the University of Utah Hospital and the Huntsman Mental Health Institute, both in Salt Lake City, recently announced details about the three innovative surgical methods they employed to assist patients with treatment-resistant OCD and MDD. These novel surgical methods are available only at a few hospitals in the U.S. In the Mountain West region, U of U Health is the only institution to offer these surgical interventions.
A functional neurosurgeon at the U of U Health’s Clinical Neurosciences Center, Ben Shofty, MD, PhD, stated, “These treatments are highly effective. Considering these patients have failed everything else, I think the treatments are potentially life-changing. These patients can actually go back to living relatively normal lives.”
Dr. Shofty added, “We had an OCD patient who was basically house-ridden for more than 3 years. Leaving his house would take 4 to 6 hours because he had to do so many rituals and compulsions. We operated on him successfully; 6 months later, he was back at work. He still has OCD, but he manages it.”
The U of U Health indicated that in order for a patient to be considered for their surgical interventions for OCD and MDD, the patient must have availed all other therapeutic options for at least 5 years.
One of the surgical procedures used includes deep brain stimulation (DBS), which entails surgically implanting a small electrode that provides an electrical current directly to specific areas of the brain. The DBS technique has been employed for over 3 decades, particularly for movement disorders such as Parkinson’s disease and essential tremors, and the FDA approved it for OCD in 2009.
Another surgical procedure is laser ablation, a minimally invasive technique that utilizes lasers under MRI guidance to target and obliterate the specific brain cells that cause OCD.
The use of surgical procedures for treatment-resistant depression is a more recent field, so vagus nerve stimulation (VNS) procedures are currently performed in clinical trial settings, with results that fluctuate contingent upon the parameters of the specific clinical trial. VNS employs an implantable device that delivers mild, intermittently pulsed signals to the vagus nerve in the neck to adjust neuronal firing in brain regions responsible for OCD symptoms.
The typical hospital recovery time for laser ablation is 1 day, while most patients undergoing DBS and VNS are discharged after 2 days.
At U of U Health, psychiatrists Brent Kious and Brian Mickey perform comprehensive patient evaluations before a surgical procedure is performed. If they ascertain that the patient is eligible, Dr. Shofty performs the appropriate surgical procedure at the U of U Health Clinical Neurosciences Center. In addition, all three physicians are working to create a clinical trial program to innovate these approaches further.
Lastly, Dr. Shofty stated, “One of the good things about these therapies is that they allow treatment-resistant patients to respond to medication and psychological therapies such as exposure and response prevention. The interventions help enormously, but just as important, they enable patients to respond to other types of therapies.”
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