Deep brain stimulation for obsessive-compulsive disorder: past, present, and future.
Obsessive-compulsive disorder (OCD) is a psychiatric illness that can lead to chronic functional impairment. Some patients with severe, chronic OCD have been treated with ablative neurosurgical techniques over the past 4 decades. More recently, deep brain stimulation (DBS) has been investigated as a therapy for refractory OCD, and the procedure was granted a limited humanitarian device exemption by the FDA in 2009. In this article, the authors review the development of DBS for OCD, describe the current understanding of the pathophysiological mechanisms of the disorder and how the underlying neural circuits might be modulated by DBS, and discuss the clinical studies that provide evidence for the use of this evolving therapy. The authors conclude with suggestions for how a combined basic science and translational research approach could drive the understanding of the neural mechanisms underlying OCD as well as the clinical effectiveness of DBS in the setting of recalcitrant disease.
Mian
Matthew K
MK
Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Campos
Michael
M
Sheth
Sameer A
SA
Eskandar
Emad N
EN
D055011:Ablation Techniques / Q000379:methods; D000818:Animals; D001921:Brain / Q000503:physiopathology / Q000601:surgery; D057176:Compassionate Use Trials; D046690:Deep Brain Stimulation / Q000266:history / Q000379:methods* / Q000639:trends; D005544:Forecasting; D017408:Guidelines as Topic / Q000592:standards; D049673:History, 20th Century; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D018579:Patient Selection; D057170:Translational Research, Biomedical; D016896:Treatment Outcome