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

Neurosurgical Approaches for Treatment-Resistant Obsessive-Compulsive Disorder

Ben Shofty  1 , Ron Gadot  2 , Nicole Provenza  2 , Eric A Storch  3 , Wayne K Goodman  3 , Sameer A Sheth  4
Affiliations
Review

Neurosurgical Approaches for Treatment-Resistant Obsessive-Compulsive Disorder

Ben Shofty et al. Psychiatr Clin North Am. 2023 Mar.

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.

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