Invasive and Non-invasive Neurostimulation for OCD.
Authors: Bergfeld IO, Dijkstra E, Graat I, de Koning P, van den Boom BJG, Arbab T, Vulink N, Denys D, Willuhn I, Mocking RJT
Journal: Current topics in behavioral neurosciences
Deep brain stimulation
Neuromodulation
Transcranial magnetic stimulation
Treatment outcome
Working mechanisms
Deep Brain Stimulation
Humans
Neuroimaging
Obsessive-Compulsive Disorder
Transcranial Magnetic Stimulation
Ventral Striatum
Abstract
It becomes increasingly clear that (non-)invasive neurostimulation is an effective treatment for obsessive-compulsive disorder (OCD). In this chapter we review the available evidence on techniques and targets, clinical results including a meta-analysis, mechanisms of action, and animal research. We focus on deep brain stimulation (DBS), but also cover non-invasive neurostimulation including transcranial magnetic stimulation (TMS). Data shows that most DBS studies target the ventral capsule/ventral striatum (VC/VS), with an overall 76% response rate in treatment-refractory OCD. Also TMS holds clinical promise. Increased insight in the normalizing effects of neurostimulation on cortico-striatal-thalamic-cortical (CSTC) loops - through neuroimaging and animal research - provides novel opportunities to further optimize treatment strategies. Advancing clinical implementation of neurostimulation techniques is essential to ameliorate the lives of the many treatment-refractory OCD patients.