Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach

Area of Science:

• Neuroscience
• Psychiatry
• Neurosurgery

Background:

• Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric condition affecting 20% of patients resistant to standard treatments.
• Refractory OCD significantly impairs social and professional functioning, leading to high healthcare costs and increased suicide risk.

Purpose of the Study:

• To review functional neuroimaging findings for various deep brain stimulation (DBS) targets in refractory OCD.
• To elucidate the underlying neural networks modulated by different DBS targets.
• To guide the selection of optimal DBS targets for individual OCD patients.

Main Methods:

• Analysis of functional neuroimaging studies investigating DBS targets for OCD.
• Examination of functional connectivity patterns associated with effective stimulation sites.
• Review of clinical outcomes and efficacy data for different DBS targets.

Main Results:

• All investigated DBS targets (ALIC, VC/VS, NAcc, amSTN, ITP) modulate overlapping neural networks implicated in OCD.
• Effective stimulation sites connect specific prefrontal cortex regions with subcortical structures.
• The anteromedial subthalamic nucleus (amSTN) target has the most robust evidence, while VC/VS-DBS and ALIC-DBS may also improve mood and behavioral adaptability.

Conclusions:

• Current DBS targets for refractory OCD operate within a shared diseased neural network.
• Understanding individual functional connectivity is crucial for personalizing DBS target selection.
• Further research is needed to optimize DBS treatment strategies for heterogeneous OCD presentations.