Open AccessSurgical Neuroanatomy and Programming in Deep Brain Stimulation for Obsessive Compulsive Disorder
Author(s) -
Morishita Takashi,
Fayad Sarah M.,
Goodman Wayne K.,
Foote Kelly D.,
Chen Dennis,
Peace David A.,
Rhoton Albert L.,
Okun Michael S.
Publication year - 2014
Publication title -
neuromodulation: technology at the neural interface
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.296
H-Index - 60
eISSN - 1525-1403
pISSN - 1094-7159
DOI - 10.1111/ner.12141
Subject(s) - deep brain stimulation , movement disorders , neuroanatomy , psychology , medicine , disease , parkinson's disease , neuroscience , pathology
Objectives Deep brain stimulation ( DBS ) has been established as a safe, effective therapy for movement disorders ( P arkinson's disease, essential tremor, etc.), and its application is expanding to the treatment of other intractable neuropsychiatric disorders including depression and obsessive‐compulsive disorder ( OCD ). Several published studies have supported the efficacy of DBS for severely debilitating OCD . However, questions remain regarding the optimal anatomic target and the lack of a bedside programming paradigm for OCD DBS . Management of OCD DBS can be highly variable and is typically guided by each center's individual expertise. In this paper, we review the various approaches to targeting and programming for OCD DBS . We also review the clinical experience for each proposed target and discuss the relevant neuroanatomy. Materials and Methods A PubMed review was performed searching for literature on OCD DBS and included all articles published before M arch 2012. We included all available studies with a clear description of the anatomic targets, programming details, and the outcomes. Results Six different DBS approaches were identified. High‐frequency stimulation with high voltage was applied in most cases, and predictive factors for favorable outcomes were discussed in the literature. Conclusion DBS remains an experimental treatment for medication refractory OCD . Target selection and programming paradigms are not yet standardized, though an improved understanding of the relationship between the DBS lead and the surrounding neuroanatomic structures will aid in the selection of targets and the approach to programming. We propose to form a registry to track OCD DBS cases for future clinical study design.