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DBS for Obsessive - Compulsive Disorder

Principal Investigator(s): Dr. Nicole Provenza

Despite FDA approval for deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) in the form of a Humanitarian Device Exemption, this therapy remains underutilized and poorly understood. Based on the pathologically avoidant phenotype underlying OCD and the pro-approach behavior required to overcome fear- based avoidance, we conceptualize our study of the neurophysiological underpinnings of OCD by tracking behavior and ventral striatum neural activity along the approach-avoidance axis. Doing so would create a foundational understanding of the neurobehavioral effects of DBS that will generalize to other disorders characterized by dysregulation of behavior along the approach-avoidance axis.

DBS in OCD, image from Nature 2024 paper

Illustration depicting prototypical clinical/behavioral states associated with OCD and its treatment with DBS. From left to right: Avoidant rituals of the severely symptomatic state, adaptive behaviors of clinical response, excessively approachful behaviors of over-stimulation, balanced sleep/wake patterns characteristic of clinical response.

DBS for Treatment-Resistant Bipolar Depression

Principal Investigator(s): Dr. Wayne Goodman, Dr. Sameer Sheth, Dr. Nicole Provenza, Dr. Jeffrey Herron

Bipolar disorder, an often-debilitating condition associated with a high risk for suicide, is characterized by dramatic and recurrent shifts in mood, energy levels and behavior ranging from the lows of depression (lasting weeks or months) to the highs of mania (lasting at least a week). There is an urgent need for more effective treatments of the depressive phase of bipolar disorder; accordingly, this study will test whether deep brain stimulation (DBS), a neurosurgical procedure widely using in movement disorders, is effective and safe in 10 patients with bipolar depression. To reduce the risk of inducing mania, emerging signs such as decreased need for sleep, increased activity, rapid speech, and elevated mood, will be monitored using a variety of mobile monitoring methods (e.g., wearables, smart phone readouts, audio diaries, etc.) together with recording of brain activity by the DBS device.

DBS for Treatment-Resistant Depression

Principal Investigator(s): Dr. Sameer Sheth, Dr. Wayne Goodman, Dr. Nader Pouratian

There is a large unmet need for developing new approaches to Treatment-Resistant Depression (TRD), a highly prevalent and debilitating disorder with major impact on public health. Clinical trials investigating deep brain stimulation (DBS), a neurosurgical approach widely used in neurological disorders, in the treatment of TRD have led to inconsistent results, possibly due to inadequate technology to precisely identify, target, and modulate the abnormal networks that mediate this disorder. The proposed studies will investigate the feasibility and safety of using a next-generation DBS system to “steer” stimulation simultaneously to two different brain regions implicated in TRD that may lead to new and better treatments for this and other severe neuropsychiatric disorders.

Katie's Story

“I’ve suffered from OCD for as long as I can remember,” says Katie Whitson, a woman from Florida with extremely severe obsessive-compulsive disorder. “OCD is a particularly vicious disease – While I was fully conscious and aware that my anxious thoughts and compulsive behaviors were not entirely rational, there was nothing I could do to stop those intrusive thoughts or obsessive behaviors.”

Despite years of therapies, several types of medications, and intensive outpatient and residential programs, Katie’s OCD symptoms continued to worsen.

“I was very anxious about contamination and germs. During my worst OCD episodes, I simply could not leave my bedroom or house for months” Whitson added. “My life had shrunk tremendously, and I was a tiny fragment of who I was. I felt completely unrecognizable to myself, my family, and my friends.

I read about this new surgical procedure called deep brain stimulation and found that a team at Baylor College of Medicine were leaders in that type of surgery,” she added. Soon after her initial conversation with the BCM team Katie enrolled in a research study on an innovative form of DBS for OCD being conducted by Dr. Wayne Goodman, professor and D.C. and Irene Ellwood Chair of the Menninger Department of Psychiatry and Behavioral Sciences, Dr. Sameer Sheth, professor of Neurosurgery and Cullen Foundation Endowed Chair, and Dr. Nicole Provenza, assistant professor of Neurosurgery and biomedical engineer. Her surgery was performed in August 2020, and Katie is now back to her career and has even been able to start a family.

“It has been four years since that surgery, and I can say without a doubt that it 100% saved my life,” Whitson said. “The last four years have been an amazing blessing for me and my family.”

Dr. Sheth, Katie, and Dr. Provenza (left to right) advocating for federal research funding for human neuromodulation therapies (June 2023).