Answer Man

Doctors using electricity to zap obsessive thoughts

MCT

Q. My wife is obsessive compulsive. Medications make her ill and counseling has not helped a great deal. Do you know of anything else available?

— M.F., of Belleville

A. First, my heartfelt best wishes to you and your wife because I know what you are going through. Years ago, I had a very dear friend who was frequently consumed by the thought that she had failed to check something or other after leaving her apartment. I can’t begin to tell you how many extra miles we often drove returning to her home so she could make sure she had turned off the gas or unplugged an electric skillet to put her mind at ease for the rest of the evening.

As you know, treatment in most cases has come in two forms: psychotherapy and medication. Through a form of behavior modification known as exposure and ritual prevention, patients gradually learn to tolerate the anxiety that arises when they are not allowed to perform their ritualistic pattern such as washing their hands umpteen times. For example, a patient may be asked to go for increasingly longer periods of time or distances before returning to his apartment to see if he had locked it. Eventually, the theory goes, the patient will be able to put the thought out of his mind — or at least shove it in a back corner. Some say this is an effective treatment, but others argue that studies may be flawed.

The same holds true for drugs as you’ve found. Drugs known as selective serotonin reuptake inhibitors (SSRIs) are often the first choice in treating those in whom OCD causes moderate to severe impairment, but they don’t work in all cases and some may not tolerate the drugs.

Now, there’s a third line of attack, and the groundwork for it was laid right across the river at St. Louis University Hospital. It’s called deep brain stimulation, which you may be familiar with in the treatment of another common ailment — Parkinson’s disease.

In deep brain stimulation, electrodes are surgically implanted into the brain through dime-size incisions. Once placed, they are connected to a neurostimulator placed in the chest or abdomen. The stimulator sends an electric current to the leads, which transmit the current into the brain tissue at carefully mapped locations. In Parkinson’s, the current helps control the disease’s characteristic tremors, muscle stiffness and walking problems in patients who have become insensitive to drugs such as levodopa. The mechanism is thought to be much the same in helping OCD patients.

“A tremor from Parkinson’s is an excess motor activity in the brain,” explained Dr. Richard Bucholz, vice chairman of St. Louis University’s department of neurosurgery. “Similarly, compulsions from OCD are excess thoughts in the brain. Suppressing those thoughts through DBS is very similar to what we have done for years in treating movement disorder.”

In 2014, experts writing in the journal Neurosurgery recommended deep brain stimulation for OCD cases that do not respond to medication, and the treatment has been approved by the Food and Drug Administration. The technology to place the leads was developed by Bucholz at St. Louis University. Hospitals around the world use his surgical system called StealthStation, an image-guided mechanism that allows surgeons to insert those electrodes into the brain with great precision. OCD affects an estimated 2 million people in the United States. The first procedure for OCD in St. Louis was done July 6.

“This is a culmination of 30 years of work,” Bucholz said. “Psychiatric disease is a true condition, and OCD can be terribly debilitating. This procedure helps these people overcome their compulsions and rejoin society.”

Q. A friend said he has heard that not all patients with appendicitis may need surgery. Can that be true? — C.N., of Fairview Heights

A. The last place you want to feel pain is in your right lower abdomen, because if it is appendicitis, chances are you’re on the fast track to the operating room. And while many of the inflamed organs are now removed through minimally invasive surgery, there are still the medical risks, recovery time and expense.

Now, however, doctors in Finland say not everyone may have to undergo the knife. They recently randomly assigned 530 patients diagnosed with uncomplicated acute appendicitis to undergo surgery or be treated first with antibiotics. As expected, all but one of the 273 patients who underwent surgery had their cases successfully resolved. But of those who took the drugs, 73 percent — nearly three of every four — were able to avoid the O.R. during the one-year follow-up. And of the 70 antibiotic-first patients who eventually did have surgery, there were no complications. The study was reported in the June 16 issue of the Journal of the American Medical Association.

“This study adds credence to the others cited (that) it is within the realm of standard practice to consider non-surgical treatment of uncomplicated appendicitis,” said Dr. Gil Ross, senior director of medicine and public health at the American Council on Science and Health. “I’m certain more such studies are in the works, and I’d predict that more and more often, patients will be encouraged to avoid surgery.”

Appendicitis will strike about 300,000 Americans each year, and, until nowat least, 10 percent of Americans could look forward to surgery for the condition sometime during their life.

Today’s trivia

Why are canned herring called “sardines”?

Answer to Saturday’s trivia: With all the heated debate going on about raising the minimum wage, it should come as no surprise that the United States was slow to adopt the idea in the first place. The first national minimum wage law was enacted in New Zealand in 1894, followed by Australia in 1896 and Great Britain in 1909, according to “Minimum Wage Fixing” by Gerald Starr in 1993. Led by Massachusetts, individual states began passing such laws in 1912, but the United States as a whole didn’t follow suit until 1933, when the National Industrial Recovery Act forced employers to pay at least 25 cents an hour. “No business which depends for existence on paying less than living wages to its workers has any right to continue in this country,” President Franklin Roosevelt had said in arguing for the standard. Yet as it had for many state laws, the U.S. Supreme Court in 1935 rendered the NIRA unconstitutional. It wasn’t until 1938 that the Fair Labor Standards Act re-established that 25-cent minimum wage ($4.04 in today’s dollars). This time, the Supreme Court upheld the law, saying in U.S. v. Darby Lumber Co. that Congress could set employment conditions under the Commerce Clause.

Send your questions to Roger Schlueter, Belleville News-Democrat, 120 S. Illinois St., P.O. Box 427, Belleville, IL 62222-0427, rschlueter@bnd.com or call 618-239-2465.

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