Mega Doctor News
By Perelman School of Medicine at the University of Pennsylvania
Newswise – PHILADELPHIA — A specific pattern of brain activity in a frontal brain region is linked to compulsive behaviors like excessive hand washing, chronic hair-pulling, and skin-picking in people with obsessive compulsive disorder, according to new research from the Perelman School of Medicine at the University of Pennsylvania. But briefly disrupting that signal can rapidly ease symptoms three people with severe, treatment resistant OCD, according to a study published this month in Cell by scientists at.
“Compulsive thoughts and behaviors can vary widely across people with OCD,” said senior author, Casey Halpern, MD, a professor of Neurosurgery and division head of Functional and Stereotactic Neurosurgery. “Identifying brain activity that is consistent despite individuals having different symptoms is a huge step forward in developing new therapies to manage OCD symptoms.”
What’s happening in the brain
Abnormally powerful high-frequency brain-circuit activity occurs in an area of the frontal cortex called the anteromedial orbitofrontal cortex (amOFC) during symptoms of OCD. The amOFC is thought to be involved in risk-versus-reward decision making, which can be disrupted in people with OCD.
In three OCD patients who had not found relief with medication or psychotherapy, researchers implanted electrodes to stimulate a small brain region deep in the right side of the brain—called the nucleus accumbens–ventral pallidum. After placing the probes, a team of neuroscientists and psychiatrists gave the patients verbal and visual prompts that were designed to elicit OCD symptoms. For example, one participant who is often triggered by contamination was encouraged to touch various dirty objects, like the bottom of a shoe. During that exercise, the team monitored her brain activity as she became distressed. They found a signal correlating strongly with OCD symptoms in all three patients in the right amOFC. They also found that when the amOFC was stimulated, the activity lessened and symptoms disappeared.
New strategies for managing OCD
OCD currently affects about two percent of people in the United States, and involves intrusive, obsessive thoughts that can lead to repetitive, compulsive behaviors, like cleaning, checking on things, and mental acts like counting that are disruptive to daily life. The disorder can cause significant emotional distress or interfere with social interactions. While OCD often responds to antidepressant drugs and/or psychotherapy, at least 30 percent of patients are not helped by either strategy.
Since 2009, deep brain stimulation (DBS) has been approved by the Food and Drug Administration, under a Humanitarian Device Exemption, to treat severe, treatment-resistant OCD in adults. This type of DBS delivers continuous stimulation to a set of brain structures deep within the brain but interconnected with the frontal cortex. It is effective for about sixty percent of patients who receive it, and is thought to work by disrupting abnormal, OCD-related patterns of activity in the brain circuits that run between the basal ganglia and frontal cortex, the areas responsible for motivation, learning, and habit formation.
“Our focus in this study is zeroing in on the exact brain structures and circuits involved in OCD symptoms, so that we can optimize electrode placement for future patients,” said the study’s first author, Younghoon Nho, PhD, a research associate in the department of Neurosurgery. “Our overall goal is to use this signaling to develop a responsive DBS system that monitors brain activity but only delivers stimulation when OCD symptoms are triggered, which our previous research has suggested is an effective strategy for treating OCD.”
Researchers hope that responsive DBS will lead to more precise treatments that are tailored to each individual patient’s symptoms, according to co-author Katherine Scangos, MD, PhD, an associate professor of Psychiatry.
The study was supported by the National Institutes of Health (NCT05623306), the Foundation for OCD Research (FFOR) and AE Foundation.
About Penn Medicine: Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System (UPHS) and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation’s top recipients of funding from the National Institutes of Health, with $580 million awarded in the 2023 fiscal year. Home to a proud history of “firsts,” Penn Medicine teams have pioneered discoveries that have shaped modern medicine, including CAR T cell therapy for cancer and the Nobel Prize-winning mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System cares for patients in facilities and their homes stretching from the Susquehanna River in Pennsylvania to the New Jersey shore. UPHS facilities include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Doylestown Health, Lancaster General Health, Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, chartered in 1751. Additional facilities and enterprises include Penn Medicine at Home, GSPP Rehabilitation, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is an $11.9 billion enterprise powered by nearly 49,000 talented faculty and staff.
