Casey Halpern, M.D.
Assistant Professor of Neurosurgery, Stanford University
“OCD is a medical problem like any other. As a society, we need to be equally as tender to these kinds of patients as we are to all others, recognizing that OCD is not the patient’s fault.”
My work with treatment-resistant ocd
I’m a neurosurgeon. I work with those patients who are most severely affected by OCD, whose symptoms do not respond to cognitive behavioral therapy or medication, and help them find relief through a surgical procedure known as deep brain stimulation (DBS). DBS is a therapy that involves electrodes placed strategically in or on specific targets of the brain, and an electrical pulse delivered through a pacemaker-like device placed under the skin. It is often used to treat neurological diseases like Parkinson’s and epilepsy, where a specific part of the brain is implicated in the onset of a seizure or involuntary tremor.
DBS for therapy
My hope is that, for OCD patients who need this kind of invasive therapy, we define the “sweet spot”— a location in the brain where we can place an electrode that can detect the onset of an obsession, deliver a brief amount of electricity to disrupt it, and cause the associated compulsion to vanish. While this approach in its current form provides some relief to the few patients who undergo DBS surgery, outcomes have not been optimized. We plan to develop more successful strategies to target DBS electrodes to each individual’s symptoms. If we can find signals in the brain that correlate with the disease severity and guide DBS future treatment, this major advance could also lead to the development of a non-invasive strategy to benefit a much broader audience.
DBS for research
Our goal is to develop new therapies that don’t require invasive techniques or intervention, but the only way to do that is to get into the brain. If we aren’t able to get into the brain to help those patients with the severest forms of OCD, then we’ll never get out of the brain to help them non-invasively. My role, as a surgeon, is to develop a trial that could improve on what today is considered a very aggressive approach for patients with severe OCD.
Relief that changes (and saves) lives
So many of these patients can’t function in everyday life and would rather quit. That doesn’t necessarily mean they’re suicidal, but if given the choice, they may not actually prefer to live—these are the patients I knew from the beginning of my career that I most wanted to help.