Deep Brain Stimulation Response Circuits in Obsessive-Compulsive Disorder.

In the field of deep brain stimulation (DBS), 2 major themes are currently making significant progress. The first of these is the framework of connectomic DBS, in which circuits that are associated with improvements of specific symptoms are described and targeted to improve and potentially personalize treatment. The second theme is related to the concept of brain sensing and adaptive DBS, which are aimed at identifying neural biomarkers that may guide stimulation in a closed-loop fashion. In DBS for obsessive-compulsive disorder (OCD), substantial progress has been made on both ends over the last 5 years. Together, the results have begun to draw a picture of exactly which circuit is associated with treatment response and how it may be affected by dysfunctional brain activity that may be attenuated using DBS. This knowledge, if further refined and validated, will define where, when, and how to stimulate which patients with OCD. We review the key studies from recent years with the aim of aggregating and condensing findings along both spatial and temporal domains. The result is a concept that anatomically defines a circuit that is likely dysfunctional in patients with typical OCD phenotypes and that may be adaptively targeted using DBS to maximally improve symptoms.