Rambam Health Care Campus is one of only a few medical centers in Israel offering deep brain stimulation for complex neurological conditions that defy traditional therapies. For one 40-year-old woman, a slightly different approach represented her final hope.
Recognized by the U.S. Food and Drug Administration, deep brain stimulation (DBS) is an established therapy for extreme cases of treatment-resistant obsessive-compulsive disorder (OCD) in adults, and Rambam Health Care Campus (Rambam) is one of the few medical centers in Israel that offers DBS.
In a standard procedure, two electrodes are implanted deep in the brain and connected to a subcutaneous “brain pacemaker.” By mapping brain activity in real-time, clinicians develop an individualized plan to deliver calibrated electrical pulses to affected regions. A more advanced therapeutic approach is dual-site DBS, which uses four electrodes to stimulate two distinct brain regions simultaneously.
Shoshana* has battled severe OCD for years and it steadily overtook her life. A mother and wife in her 40s from Northern Israel, her life unraveled as the illness took over her daily routines.
Shoshana’s psychiatrist referred her to Rambam for a specialized evaluation. Given the severity of her case, the surgical team decided on the dual-site approach.
For Shoshana it was her final resort: “I’m pinning all my hopes on this treatment,” she said when agreeing to the treatment. “I’ve tried everything and this is my last chance for a normal life.”
The procedure was performed by Dr. Lior Lev-Tov, director of the Functional Neurosurgery Unit at Rambam, in a first-of-its-kind dual-target DBS procedure in Israel for OCD.
“During treatment, we are essentially stimulating neural pathways—the communication infrastructure between the brain’s control centers,” explains Dr. Lev-Tov. “In real-time, we can see how stimulating a specific region alters communication and produces a desired response in another focal point. In Shoshana’s case, when we stimulated and recorded activity at four different sites simultaneously, the responses were significantly stronger and more effective.”
Professor Hagai Bergman from the Hebrew University of Jerusalem and Hadassah Medical Center, who attended the surgery, noted that this was the first time in Israel that electrodes were implanted in two brain targets to enable optimal stimulation. While using four electrodes instead of two may sound like a mere technicality, experts say it could expand DBS options for patients who do not respond adequately to single-target stimulation, and may open new avenues for other severe psychiatric and neurological conditions.
By targeting multiple sites in the brain’s circuitry, clinicians can manage a broader range of symptoms, potentially meaningful clinical improvement. “Shoshana’s post-procedure measurements are excellent,” notes Dr. Lev-Tov. “The procedure went well and she is already showing a marked improvement in her symptoms. We are currently calibrating the pacemaker as part of her long-term psychiatric follow-up, and we’re quite optimistic regarding her continued improvement as the system is fine-tuned over time.”
Strict criteria govern the use of DBS in Israel, requiring at least a five-year diagnosis and a history of failed conventional treatments. Currently, the procedure for OCD is not included in the national “health basket” of subsidized services and is offered only via specific Ministry of Health approvals or clinical trials.
However, the global success rates for this multi-target technique are promising, standing at approximately 80% for treatment-resistant patients. Experts believe this approach could eventually offer breakthroughs for other conditions, including epilepsy, severe depression, and movement and eating disorders.
“The ability to customize treatment to the specific neural architecture of a patient allows us to provide solutions for people who have been incapacitated by illness for years,” says Dr. Lev-Tov. “This is about helping them restore function and, ultimately, get their lives back.”
*Name changed to protect patient privacy.
Click the picture below to watch a video of Dr. Lior Lev Tov explaining the procedure.
