Obsessive–compulsive disorder (OCD) is a mental disorder characterized by intrusive, distressing, and uncontrollable thoughts (obsessions), alongside compulsive rituals and behaviors intended to reduce anxiety — but in practice may maintain it. The rituals take up a great deal of time, impair daily functioning, and can paralyze entire lives.
About 1.2% of the population suffers from OCD, and a significant proportion of them develop resistance to standard treatments — pharmacological and psychological. In such cases, treatment options become increasingly limited, and the damage to quality of life can be particularly severe.
One of them is S. — a mother and wife in her 40s from the north — who coped for years with OCD that progressively worsened, until it affected almost every area of her life: Her relationship, parenting, independence, and ability to function. After more than five years of treatments that did not help — medications, psychotherapy, and various combinations — S. was referred to a treatment option that is rare in Israel: Deep brain stimulation (DBS), and in her case — using a new technique that had not yet been implemented here.
The procedure, performed at the Rambam Medical Center in Haifa, involved the implantation of four electrodes in two different areas of the brain, as opposed to the conventional method in which two electrodes are implanted in a single area. This is the first surgery of its kind in Israel, intended to improve the ability to regulate abnormal brain activity in cases of particularly treatment-resistant OCD.
What is deep brain stimulation — and who is it intended for?
DBS has been a recognized treatment for about 15 years for neurological diseases such as Parkinson’s, and later also for severe and treatment-resistant psychiatric disorders, including OCD and severe depression. The treatment has been approved by the FDA in the United States for extreme cases of OCD, but in Israel it is not yet included in the health basket and is provided only in exceptional cases, after special approval or within a research framework.
During the procedure, electrodes are inserted into deep areas of the brain and connected to a subcutaneous electrical pacemaker. The pacemaker sends gentle electrical pulses intended to change abnormal activity patterns in neural pathways related to emotional regulation, anxiety, and impulse control.
“The goal is not to ‘turn off’ an area of the brain but to balance its activity,” explains Dr. Renana Eitan, director of the neuropsychiatric clinic at Kfar Shaul, who accompanies S. “There are several areas relevant to OCD, and in some cases stimulating one area is not enough.”
According to Dr. Lior Lev-Tov, head of the functional neurosurgery unit at Rambam who performed the surgery, the new method allows for broader and more precise influence: “We simultaneously stimulate two different neural pathways, which are part of separate but interconnected circuits,” he explains. “This way it is possible to affect more symptoms at the same time and improve the chances of response in particularly difficult patients.”
According to Prof. Hagai Bergman from the Hebrew University and Hadassah, who was present during the surgery, this is a milestone: “This is the first time in Israel that such a technique has been implemented in a patient with severe OCD. It opens the door to deeper personalization of treatment.”
And what about the results?
According to data from studies abroad, response rates with this method may reach about 80% in particularly treatment-resistant patients. In S.’s case, the initial measures after the surgery were very positive, and she is currently in the pacemaker-adjustment phase as part of long-term psychiatric follow-up.
The researchers emphasize that this is still a relatively experimental treatment that requires continued research and follow-up, but its potential is significant — not only for OCD, but also for treatment-resistant depression, eating disorders, epilepsy, and movement disorders.