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Neuromodulation for obsessive-compulsive disorder.

Authors
  • Lapidus, Kyle A B1
  • Stern, Emily R
  • Berlin, Heather A
  • Goodman, Wayne K
  • 1 Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA, [email protected]
Type
Published Article
Journal
Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics
Publication Date
Jul 01, 2014
Volume
11
Issue
3
Pages
485–495
Identifiers
DOI: 10.1007/s13311-014-0287-9
PMID: 24981434
Source
Medline
License
Unknown

Abstract

Neuromodulation shows increasing promise in the treatment of psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Development of tools and techniques including deep brain stimulation, transcranial magnetic stimulation, and electroconvulsive therapy may yield additional options for patients who fail to respond to standard treatments. This article reviews the motivation for and use of these treatments in OCD. We begin with a brief description of the illness followed by discussion of the circuit models thought to underlie the disorder. These circuits provide targets for intervention. Basal ganglia and talamocortical pathophysiology, including cortico-striato-thalamo-cortical loops is a focus of this discussion. Neuroimaging findings and historical treatments that led to the use of neuromodulation for OCD are presented. We then present evidence from neuromodulation studies using deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation, with targets including nucleus accumbens, subthalamic nucleus inferior thalamic peduncle, dorsolateral prefrontal cortex, supplementary motor area, and orbitofrontal cortex. Finally, we explore potential future neuromodulation approaches that may further refine and improve treatment.

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