Deep brain stimulation for obsessive compulsive disorder: Evolution of surgical stimulation target parallels changing model of dysfunctional brain circuits

Patrick J. Karas, Sungho Lee, Joohi Jimenez-Shahed, Wayne K. Goodman, Ashwin Viswanathan, Sameer A. Sheth

Research output: Contribution to journalReview articlepeer-review

25 Scopus citations

Abstract

Obsessive compulsive disorder (OCD) is a common, disabling psychiatric disease characterized by persistent, intrusive thoughts and ritualistic, repetitive behaviors. Deep brain stimulation (DBS) is thought to alleviate OCD symptoms by modulating underlying disturbances in normal cortico-striato-thalamo-cortical (CSTC) circuitry. Stimulation of the ventral portion of the anterior limb of the internal capsule (ALIC) and underlying ventral striatum (“ventral capsule/ventral striatum” or “VC/VS” target) received U.S. FDA approval in 2009 for patients with severe, treatment-refractory OCD. Over the decades, DBS surgical outcome studies have led to an evolution in the electrical stimulation target. In parallel, advancements in neuroimaging techniques have allowed investigators to better visualize and define CSTC circuits underlying the pathophysiology of OCD. A critical analysis of these new data suggests that the therapeutic mechanism of DBS for OCD likely involves neuromodulation of a widespread cortical/subcortical network, accessible by targeting fiber bundles in the ventral ALIC that connect broad network regions. Future studies will include advances in structural and functional imaging, analysis of physiological recordings, and utilization of next-generation DBS devices. These tools will enable patient-specific optimization of DBS therapy, which will hopefully further improve outcomes.

Original languageEnglish (US)
Article number998
JournalFrontiers in Neuroscience
Volume13
Issue numberJAN
DOIs
StatePublished - 2019
Externally publishedYes

Keywords

  • Brain circuitry
  • DBS
  • OCD
  • Operative
  • Review
  • Surgical procedures

ASJC Scopus subject areas

  • Neuroscience(all)

Fingerprint

Dive into the research topics of 'Deep brain stimulation for obsessive compulsive disorder: Evolution of surgical stimulation target parallels changing model of dysfunctional brain circuits'. Together they form a unique fingerprint.

Cite this