Brain Stimulator Implant at OHSU Controls Seizures and OCD

A patient at Oregon Health & Science University is the first in the world to benefit from a single brain stimulator implanted to effectively regulate two life-altering conditions: epileptic seizures and compulsive behavior caused by obsessive-compulsive disorder, or OCD.

Amber Pearson, 34, of Albany, said her seizures have improved, but the relief from her psychiatric illness has been significant.

“OCD is worse than having the seizures,” she went on to say. “Epilepsy brings limitations to my life, but OCD controlled it.”

Co-authors from institutions across the country detail the interactive programming of the responsive neurostimulation system, or RNS, that now functions seamlessly to regulate the compulsions that formerly governed her life in the case study, which was published in the journal Neuron.

“Before I started treatment with my RNS, I would wash my hands until they would bleed,” stated Pearson. “My hands would be so dry that bending my fingers would crack the skin of my knuckles.”

Checking and rechecking windows and closets, as well as making sure the stove was turned off before going to bed, may take up to 45 minutes. She couldn’t eat with other people because she was afraid their food might infect hers, even during family meals during the holidays. Every time she changed the kitty box, she took a shower.

On March 5, 2019, a process at OHSU began to change all of that.

The brain stimulator was implanted by Ahmed Raslan, M.D., an OHSU School of Medicine professor of neurological surgery, with the primary goal of reducing Pearson’s seizures.

He also made sure the 32-millimeter-long electrode encompassed the nucleus accumbens — the part of the brain involved with motivation and activity, including obsessive cravings — at the patient’s request.

“I could target both portions of the brain and get a second benefit,” he said.

Raslan worked with Casey Halpern, M.D., a neurosurgeon presently at Penn Medicine who led the research phase of the treatment to treat Pearson’s OCD at Stanford University.

Marissa Kellogg, M.D., an assistant professor of neurology at the OHSU School of Medicine, first encountered Pearson as a patient in 2016 and was struck by her cheerful attitude despite severe health issues.

The first thing she told me when I met her was, ‘I want brain surgery for my epilepsy,'” she recalled.

Pearson did, in fact, undergo the routine surgery for treating drug-resistant seizures at OHSU in 2018, which involved the excision of a small area of the brain where seizures originate. Pearson opted to proceed with implanting the RNS, a relatively new form of implant that actively analyzes brain activity and provides a tiny pulse to calm seizures before they develop.

During her own investigation, she discovered that some people had stated that these implants relieved psychiatric illnesses such as OCD.

Pearson, according to Kellogg, was eager to try it.

“It was an incredible opportunity,” remarked Kellogg. “Amber is really a future-thinking patient, and she really drove the boat here.”

Kellogg, a neurologist with an interest in mental health conditions associated with epilepsy, had completed her fellowship training at Stanford and knew the team there had a strong psychiatry program with experience programming devices for off-label research purposes, all under the supervision of Stanford’s institutional review board.

Pearson saw relief from her OCD within months of receiving the brain stimulator implant. The outcome has impacted her life four years later.

“I no longer worry about what happens at my house while I’m away.” “Every day, I notice fewer obsessions and compulsions,” she stated. “I’ve been able to form healthier relationships with the people in my life.”

For More Information: Responsive deep brain stimulation guided by ventral striatal electrophysiology of obsession durably ameliorates compulsion

https://doi.org/10.1016/j.neuron.2023.09.034