Interview with Professor Sturm, Senior Professor of Neurosurgery and Stereotaxy at the University Hospital Würzburg and one of the leading surgeons in the context of Deep Brain Stimulation in Europe.
He was the clinical director of the Department for Neurosurgery and Stereotaxie at the University of Cologne for more than 20 years.
Professor Sturm was one of the world's first medical doctors who performed DBS in Obsessive-Compulsive Disorder ( OCD )
He was awarded the Erwin Schrödinger Prize 2007 for further development of Deep Brain Stimulation ( DBS ).
The Interview was made in August 2013
“The bright future of brain stimulation is according to Prof. Sturm in the treatment of severe psychiatric disorders, which are non treatable with
conventional methods, as well as obsessive-compulsive disorder, depression, Tourette's syndrome, dementia and addictions. “
Quote from the press of Jörg - Bernard - Foundation
Professor Sturm, how long do you treat OCD using Deep Brain Stimulation ?
Personally I look back on 11 years of experience in the field, added about 1000 Deep Brain Stimulations in Parkinson's Disease.
What are your experiences according to the rate of success of a DBS in OCD.
The success - rate of a significant improvement is about 65-70%.
It must be borne in mind in particular that it corresponds to a measured symptom improvement by let's say 35% of an incomparably higher quality of life.
One can say that, if successful, the patient again is suitable for everyday use, but we also had cases of complete healing.
What conditions must be present for a patient for a DBS is in Question?
A long-standing severe obsessive-compulsive disorder.
Furthermore, intensive cognitive behavior therapies must have taken place, both in form and in an outpatient of a recognized, high-quality inpatient therapy.
In addition, drug treatments with SSRI's and antidepressants at a sufficient dose and duration must have been tried.
How to you determine whether a DBS can be done or not?
This is done in close cooperation with our psychiatric department, which also conducts the preliminary investigation and decides on the basis of their investigations on the suitability of the patient and accompanied the therapy optimization closely.
The neurosurgeon never has too meet - an also cannot meet – this decision alone.
In addition, an indication is given by the clinic is a legal requirement in Germany and not questioning the competence of the referring physician.
How can we imagine the effect of the DBS?
The brain works mainly in the form of networks and control circuits.
These control loops function due to a possible predisposition and environmental influences - even psychological - no more in a correct way.
Based on our operating results, we have the hypothesis that certain circuits - are highly “over - synchronized “ and thus "over-react" - in this case between the deep brain and the frontal lobe.
What we do is this sickening rhythm to replace by our stimulation at 130 Hz - without destroying this circuit or even any brain tissue.
Since the beginning of research and first DBS more than 10 years have passed.
What technical / operational developments there since the first time and today?
At the beginning of the research around the millennium we have explored in the research network with other hospitals of different variants of the DBS in studies.
This we succeeded, by determining the best target area, by varying the flow parameters and the turning of the unilateral brain stimulation for implantation of two probes to improve the duration and quality of onset significantly.
Meanwhile, the health insurance companies in Germany cover the cost of DBS in obsessive-compulsive disorder: What does this mean for you?
This is a very big step forward and shows that the assessment, validation and recognition of the method has very positive developed.
Would you evaluate this as a kind of seal of quality with regard to the method?
Is the part of the DBS postoperative care in the context of therapies desirable, and are there any guidance from the clinics.
This is a very important question and I am glad that you ask for it.
This is more than desirable.
The brain pacemaker creates the conditions that the control loops function again.
Behavior therapy can then work again, even if it wasn ´ t successfull before, because the neurophysiological conditions are newly created to allow this to take effect again.
That would promise a significant acceleration of healing.
It is roughly comparable to a hip - operation: Here we got regularly a rehabilitation - phase around to build the muscles again and to optimize the recovery process.
The behavior therapist is absolutely free in his treatment – there are no “ orders “ of how he has to work by the clinic.
Prof. Sturm, thank you very much for this interview.