Obsessive-Compulsive Disorder: Deep Brain Stimulation

Abstract

Obsessive-compulsive disorder (OCD) is a common anxiety disorder that affects 2-3% of the population. In severe, treatment-refractory forms, it is extremely debilitating, preventing affected individuals from engaging in the most basic social and professional functions in life. Such patients are potential candidates for neurosurgical intervention, an example of which is deep brain stimulation (DBS). DBS for OCD first emerged in the late 1990s, informed by the experience with stereotactic lesion procedures, in particular anterior capsulotomy. Since then, there have been a number of open-label series and a few randomized, blinded, sham-controlled trials. DBS for OCD is approved by the US FDA under a Humanitarian Device Exemption and in Europe with the CE mark. In this chapter, we detail the development of DBS for OCD, discuss current procedural strategies and existing outcome data, and provide a glimpse of the future of this therapy.