OCD program · Istanbul

Deep brain stimulation for severe, treatment-resistant OCD

A multidisciplinary program in Istanbul that evaluates adults with severe obsessive-compulsive disorder who have not improved after full trials of medication and cognitive behavioral therapy. Every candidate is assessed jointly by psychiatry and functional neurosurgery before any surgical decision.

How to start: take the 3-minute self-check. If your score suggests severe OCD, continue to the detailed online evaluation, which our team reviews before you need to travel.

Start the 3-minute self-check Detailed online evaluation

Schematic only. Electrode position and target are planned individually for each patient.

800+patients treated with DBS by the surgical team, from more than 60 countries

≈150DBS procedures per year at the Neuromodulation Center

2specialties deciding together: psychiatry and functional neurosurgery

Condition

Obsessive-compulsive disorder

What OCD is, how it is treated first, and when a surgical option may be discussed.

Treatment

Deep brain stimulation

How the system works, what surgery involves and what the evidence shows for OCD.

Step 1 · For everyone

OCD self-check

Ten questions on symptom severity and three on past treatment. Your score is shown at once.

Step 2 · For people with OCD

Detailed online evaluation

A full questionnaire on your symptoms, health and past treatment, reviewed by our psychiatry and neurosurgery team.

Scientific collaboration

Sameer Sheth, MD, PhD · Baylor College of Medicine

Academic collaboration on patient selection, outcome measurement and research in psychiatric neurosurgery.

Deep brain stimulation

Deep brain stimulation (DBS) delivers mild, continuous electrical pulses to a specific brain circuit through thin electrodes. It has been used for movement disorders such as Parkinson's disease, essential tremor and dystonia for more than 30 years, and for selected psychiatric conditions since the early 2000s.

How it works

A DBS system has three parts: one or two electrodes (leads) placed in a deep brain target, an extension wire that runs under the skin, and a pulse generator, similar to a cardiac pacemaker, placed under the skin below the collarbone. The stimulation does not destroy tissue. It is adjustable and reversible: settings can be changed, and the system can be switched off.

In OCD, stimulation is directed at circuits that connect the frontal cortex with deep structures involved in habits, anxiety and reward. The targets used most often are the ventral capsule and ventral striatum (VC/VS), the anterior limb of the internal capsule, the nucleus accumbens and the subthalamic nucleus.

What treatment involves

Joint evaluationPsychiatric and neurosurgical review of history, prior treatments, standardized severity scales and brain MRI.
SurgeryElectrodes are placed with stereotactic planning and image guidance. The pulse generator is implanted in the same or a second session.
ProgrammingStimulation is adjusted gradually over weeks to months. Improvement in OCD usually builds over time rather than appearing at once.
Continued carePsychiatric follow-up continues after surgery. Exposure-based therapy is often more effective once symptoms ease.

Possible risks

As with any brain surgery, risks include bleeding, infection and hardware problems. Stimulation can cause temporary changes in mood, anxiety, sleep or energy, which are usually managed by adjusting the settings. Each patient receives a personal explanation of risks and expected benefits before giving consent.

About the condition

Obsessive-compulsive disorder

OCD affects about 2 to 3 people in every 100 during their lifetime. It causes intrusive, distressing thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels driven to perform, often for hours each day.

Standard treatment comes first

Most people with OCD improve with first-line care: cognitive behavioral therapy with exposure and response prevention (ERP), and serotonin reuptake inhibitor medication (SSRIs or clomipramine), often at higher doses and for longer periods than in depression. Augmentation with other medicines is added when the response is partial.

Around one in ten patients remains severely ill despite these treatments. For this small group, with careful selection, a neurosurgical option such as DBS may be discussed with their psychiatrist.

Who may be evaluated

The detailed online evaluation follows criteria used by established psychiatric neurosurgery programs. Typical requirements are summarized here; final eligibility is decided by the joint team.

Diagnosis	Primary OCD, confirmed by the treating psychiatrist
Severity	Severe symptoms with major impact on daily life, usually Y-BOCS 28 or higher
Duration	Illness lasting at least 5 years
Medication	At least 3 serotonin reuptake inhibitors (one may be clomipramine), each for 12 weeks or more at the maximum tolerated dose, plus at least one augmentation trial
Psychotherapy	More than 20 hours of CBT including exposure and response prevention
Other factors	Active psychosis, current substance dependence or a recent suicide attempt need specialist review and may delay or rule out surgery

Step 1 · about 3 minutes

OCD self-check

Ten questions about how obsessions and compulsions have affected you over the past 7 days, followed by three questions about treatment you have already had. It takes about 3 minutes. If your score suggests severe OCD, you can continue straight to the detailed online evaluation. Your answers stay on this device unless you choose to continue.

Scientific collaborations

Working with an established psychiatric neurosurgery program

The Istanbul program is developed in scientific collaboration with Dr. Sameer Sheth of Baylor College of Medicine, Houston. The collaboration focuses on rigorous patient selection, shared outcome measures and research.

Sameer Sheth, MD, PhD

Professor of Neurosurgery · Director of Psychiatric Neurosurgery

Cullen Foundation Endowed Chair McNair Scholar Vice-Chair of Clinical Research

Sameer Sheth, MD, PhD is Professor of Neurosurgery, Cullen Foundation Endowed Chair, McNair Scholar, Vice-Chair of Clinical Research, and Director of Psychiatric Neurosurgery in the Department of Neurosurgery, Baylor College of Medicine. Dr. Sheth directs the Gordon and Mary Cain Pediatric Neurology Research Foundation Laboratories at Texas Children's Hospital. He also holds joint appointments in the Department of Neuroscience and Department of Psychiatry & Behavioral Sciences at Baylor and is an Adjunct Professor in the Department of Electrical and Computer Engineering at Rice University.

Clinically, Dr. Sheth specializes in stereotactic/functional neurosurgery, including the surgical treatment of movement disorders, epilepsy, and psychiatric disorders. Dr. Sheth's research focuses on cognitive neurophysiology, using opportunities derived from his clinical work. He studies higher order human cognitive processes, including decision-making and emotional regulation, using intracranial electrophysiological recordings and non-invasive advanced imaging techniques. His lab also strives to improve neuromodulatory treatments for neurological and psychiatric disorders using surgical and non-invasive techniques.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas

Selection

Shared selection criteria

The detailed online evaluation is adapted from the psychiatric neurosurgery intake form used at Baylor College of Medicine.

Outcomes

Common measures

Standardized scales such as the Y-BOCS, recorded before surgery and at fixed follow-up points.

Education

Training and exchange

Case discussions, joint teaching and scientific meetings between the two teams.

Istanbul team

Prof. Dr. Atilla Yılmaz is a stereotactic and functional neurosurgeon and Head of the Neuromodulation Center at Medicana Ataşehir International Hospital, Istanbul. He chairs the Department of Neurosurgery at Istanbul Health and Technology University, is President of the Mediterranean Society for Stereotactic and Functional Neurosurgery (MSSFN) and of the Turkish Chapter of the International Neuromodulation Society, and serves on the boards of WSSFN, ESSFN, SEESFN and INS. He has treated more than 800 patients with DBS from more than 60 countries.

Psychiatric evaluation and follow-up are provided by the program's psychiatry team in Istanbul.

Step 2 · about 20 minutes

Detailed online OCD evaluation

This questionnaire gathers what our psychiatry and neurosurgery team need to assess whether advanced treatment, including deep brain stimulation, could be suitable for you. You can fill it in yourself, or a family member can complete it with you. Fields marked * are required; answer the rest as fully as you can. Your progress is saved in this browser as you go.

Program team only

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Deep brain stimulation for severe, treatment-resistant OCD

Obsessive-compulsive disorder

Deep brain stimulation

OCD self-check

Detailed online evaluation

Sameer Sheth, MD, PhD · Baylor College of Medicine

Deep brain stimulation

How it works

What treatment involves

Possible risks

Obsessive-compulsive disorder

Standard treatment comes first

Who may be evaluated

OCD self-check

Part A · Obsessions

Part B · Compulsions

Part C · Treatment so far

Working with an established psychiatric neurosurgery program

Sameer Sheth, MD, PhD

Shared selection criteria

Common measures

Training and exchange

Istanbul team

Detailed online OCD evaluation

Has a doctor diagnosed you with OCD?

Evaluations received