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Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder.
Neuromodulation. 2014 Jun; 17(4):312-9; discussion 319.N

Abstract

OBJECTIVES

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.

MATERIALS AND 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.

CONCLUSION

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+Show Affiliations

Department of Neurosurgery, University of Florida College of Medicine/Shands Hospital, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, FL, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

24345303

Citation

Morishita, Takashi, et al. "Surgical Neuroanatomy and Programming in Deep Brain Stimulation for Obsessive Compulsive Disorder." Neuromodulation : Journal of the International Neuromodulation Society, vol. 17, no. 4, 2014, pp. 312-9; discussion 319.
Morishita T, Fayad SM, Goodman WK, et al. Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder. Neuromodulation. 2014;17(4):312-9; discussion 319.
Morishita, T., Fayad, S. M., Goodman, W. K., Foote, K. D., Chen, D., Peace, D. A., Rhoton, A. L., & Okun, M. S. (2014). Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder. Neuromodulation : Journal of the International Neuromodulation Society, 17(4), 312-9; discussion 319. https://doi.org/10.1111/ner.12141
Morishita T, et al. Surgical Neuroanatomy and Programming in Deep Brain Stimulation for Obsessive Compulsive Disorder. Neuromodulation. 2014;17(4):312-9; discussion 319. PubMed PMID: 24345303.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical neuroanatomy and programming in deep brain stimulation for obsessive compulsive disorder. AU - Morishita,Takashi, AU - Fayad,Sarah M, AU - Goodman,Wayne K, AU - Foote,Kelly D, AU - Chen,Dennis, AU - Peace,David A, AU - Rhoton,Albert L,Jr AU - Okun,Michael S, Y1 - 2013/12/17/ PY - 2013/07/25/received PY - 2013/10/06/revised PY - 2013/10/31/accepted PY - 2013/12/19/entrez PY - 2013/12/19/pubmed PY - 2015/2/20/medline KW - Deep brain stimulation KW - inferior thalamic peduncle KW - obsessive compulsive disorder KW - subthalamic nucleus KW - ventral capsule/ventral striatum SP - 312-9; discussion 319 JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation VL - 17 IS - 4 N2 - OBJECTIVES: 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. MATERIALS AND 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. CONCLUSION: 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. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/24345303/Surgical_neuroanatomy_and_programming_in_deep_brain_stimulation_for_obsessive_compulsive_disorder_ L2 - https://doi.org/10.1111/ner.12141 DB - PRIME DP - Unbound Medicine ER -