Deep Brain Stimulation in Obsessive-Compulsive Disorder

Deep brain stimulation (DBS) is a promising treatment for patients suffering from severe obsessive-compulsive disorder (OCD) that is resistant to conventional psychotherapeutic and pharmacological therapies. Improvement of symptoms is on average about 45%, and DBS leads to both a functional improvement and an improvement of quality of life. A number of different anatomical targets are used, but current available evidence does not support the preference of any specific target over another in terms of efficacy or side effects. Lack of knowledge of differential neuroanatomical tracts underlying the various symptom dimensions of OCD and the lack of reliable biomarkers for response hamper establishing the indication for DBS, target selection, and effective programming. However, the promising results in clinical trials so far in combination with the significant progress in understanding the underlying neurocircuitry and technological developments all encourage the further development of DBS for this indication. Technological developments should be accompanied by ongoing and proactive ethical reflection. Thus, research can contribute to defining the place of DBS within treatment algorithms for OCD and will open a new perspective for OCD patients by moving the limits of refractoriness further away.