Neurosurgical Approaches for Treatment-Resistant Obsessive-Compulsive Disorder

Ben Shofty; Ron Gadot; Nicole Provenza; Eric A Storch; Wayne K Goodman; Sameer A Sheth

doi:10.1016/j.psc.2022.11.002

Neurosurgical Approaches for Treatment-Resistant Obsessive-Compulsive Disorder

Psychiatr Clin North Am. 2023 Mar;46(1):121-132. doi: 10.1016/j.psc.2022.11.002. Epub 2022 Dec 13.

Authors

Ben Shofty¹, Ron Gadot², Nicole Provenza², Eric A Storch³, Wayne K Goodman³, Sameer A Sheth⁴

Affiliations

¹ Department of Neurosurgery, University of Utah, 175 North Medical Drive East, 5th Floor, Salt Lake City, UT 84132, USA.
² Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA.
³ Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA.
⁴ Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge Street Suite 9A, Houston, TX 77030, USA; Department of Psychiatry, Baylor College of Medicine, 7200 Cambridge Street, Houston, TX 77030, USA. Electronic address: sameer.sheth@bcm.edu.

PMID: 36740348
DOI: 10.1016/j.psc.2022.11.002

Abstract

Treatment-resistant obsessive-compulsive disorder (trOCD) is a severely disabling, life-threatening psychiatric disorder affecting ∼0.5% of the US population. Following the failure of multiple medical and psychotherapeutic treatment lines, patients with trOCD, like others with functional disorders, may benefit from invasive neuromodulation. Cumulative evidence suggests that disrupting abnormal hyperdirect cortico-striato-thalamo-cortical (CSTC) pathway activity offers sustainable, robust symptomatic relief in most patients. Multiple surgical approaches allow for modulation of the CSTC pathway, including stereotactic lesions and electrical stimulation. This review aims to describe the modern neurosurgical approaches for trOCD, recent advances in our understanding of pathophysiology, and future therapeutic directions.

Keywords: DBS; Neuromodulation; Neurosurgery; OCD.

Publication types

Review

MeSH terms

Deep Brain Stimulation*
Humans
Obsessive-Compulsive Disorder* / surgery
Psychotropic Drugs

Substances

Psychotropic Drugs