Journal of Psychological Abnormalities

Obsessive-Compulsive Disorder: Connectomic Deep Brain Stimulation

Anne Marie^{* *}Correspondence: Anne Marie, Editorial Office, Journal of Psychological Abnormalities, Brussels, Belgium, Email:

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Short Commentary

Obsessive-compulsive disorder is one of the most debilitating mental illnesses. Although deep brain stimulation is thought to be a successful therapy, its usage in clinical practice has yet to be proven. This is due, at least in part, to ambiguity regarding the optimum target and a lack of understanding of the underlying mechanics. Recent research suggests that improvements in obsessions and compulsions are due to changes in larger brain networks rather than local effects at the stimulation site. Innovative methodological techniques that combined brain connection analysis with neuromodulatory therapies generated these discoveries. A neuromodulation connectomic method like this is an integrated account that seeks to describe optimum target networks. We combine data from connectomic research with deep brain stimulation therapies in this critical review to identify a neural network that may be useful in lowering obsessions and compulsions. To that end, we examine techniques and seemingly contradictory data in order to combine observations and discover common and different treatment routes for obsessive-compulsive disorder. Finally, we propose a unified network that alleviates obsessivecompulsive symptoms when modified by cortical or subcortical therapies.

For seriously afflicted and treatment-refractory instances of Obsessive-Compulsive Disorder (OCD), Deep Brain Stimulation (DBS) can be an effective treatment, but it is still not regarded a completely established therapy. This is owing, at least in part, to a lack of clarity regarding which brain networks to modify for the best therapy response. Anatomical and functional characterization of circuits that diminish obsessions and compulsions when activated might enhance the riskbenefit profile of DBS and give testable theories for OCD neuromodulation in general. Surprisingly, response rates in OCD have been shown to be comparable across different DBS targets. Previous research revealing that DBS has therapeutic benefits beyond the local/focal stimulation target sparked the idea of a larger, presumably shared brain network responsible for obsession and compulsive reduction. OCD, on the other hand, is a heterogeneous condition, with data indicating that a diverse collection of different networks may be impacted in each patient, making neuromodulatory therapy significant.

Connectomic DBS is a new neuroscientific idea that can help researchers better understand how diverse target areas work together to enhance therapeutic outcomes. We want to discover common and different pathways likely to be beneficial for decreasing obsessions and compulsions in this critical review by scrutinizing techniques and findings from connectomic research and DBS therapies for OCD. For the purpose of brevity, we only examine structural connections; relevant functional Magnetic Resonance Imaging (MRI) studies in OCD DBS are reviewed as needed.

The field of connectomic DBS for OCD has made considerable development in recent years, and the present data comes from many centers utilizing various targets and has been cross-validated in part using different connection estimates (e.g., dMRI and histology-based atlases). To overcome the challenge of connectomic DBS for OCD, we recommend that future studies 1) pool data from multiple centers for larger sample sizes, 2) focus on adequately assessed individual symptom/neuropsychological dimensions of OCD, 3) use and compare different DBS connectivity models, and 4) combine different neuromodulatory approaches for OCD. Finally, prospective studies are now required to validate findings in DBS for OCD in order to make a step toward a more personalized, precise, and hence safe and effective neuromodulation for OCD, following the pioneering example of connectomic DBS for depression.

In summary, we review evidence for a unified network spanning cortical (the dACC, vlPFC, and presumably others) and subcortical (anteromedial STN, medial dorsal nucleus of the thalamus) regions that alleviates obsessive-compulsive symptoms when modulated by DBS, ablative surgery, or noninvasive neuromodulation. We find that, despite differing terminology, there is a significant level of agreement among research, particularly when it comes to a precise surgical target location inside the ALIC. Finally, as a vital component for clinical success, we present a mechanistic model that includes a limbic/associative hyper direct circuit that travels inside the core portion of the ALIC.