title: Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder.
abstract: OBJECTIVE
  Deep brain stimulation (DBS) has been established as a safe, effective therapy for movement disorders (Parkinson'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.
  
  
  METHODS
  A PubMed review was performed searching for literature on OCD DBS and included all articles published before March 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA.
authors.forename: Takashi
authors.initials: T
authors.lastname: Morishita
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Fayad
authors.forename: Wayne K
authors.initials: WK
authors.lastname: Goodman
authors.forename: Kelly D
authors.initials: KD
authors.lastname: Foote
authors.forename: Dennis
authors.initials: D
authors.lastname: Chen
authors.forename: David A
authors.initials: DA
authors.lastname: Peace
authors.forename: Albert L
authors.initials: AL
authors.lastname: Rhoton
authors.forename: Michael S
authors.initials: MS
authors.lastname: Okun
mesh_terms: D001921:Brain / Q000033:anatomy & histology* / Q000502:physiology; D046690:Deep Brain Stimulation / Q000379:methods*; D004567:Electrodes, Implanted; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Deep brain stimulation; inferior thalamic peduncle; obsessive compulsive disorder; subthalamic nucleus; ventral capsule/ventral striatum