Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review
Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-07-01
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| Series: | Brain Sciences |
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| Online Access: | https://www.mdpi.com/2076-3425/11/7/948 |
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| author | Nicola Acevedo Peter Bosanac Toni Pikoos Susan Rossell David Castle |
| author_facet | Nicola Acevedo Peter Bosanac Toni Pikoos Susan Rossell David Castle |
| author_sort | Nicola Acevedo |
| collection | DOAJ |
| description | Invasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) ‘sweet spot’ of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette’s patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes. |
| first_indexed | 2024-03-10T09:44:31Z |
| format | Article |
| id | doaj.art-ea7c96169169429299d34721f2376eb5 |
| institution | Directory Open Access Journal |
| issn | 2076-3425 |
| language | English |
| last_indexed | 2024-03-10T09:44:31Z |
| publishDate | 2021-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Brain Sciences |
| spelling | doaj.art-ea7c96169169429299d34721f2376eb52023-11-22T03:21:26ZengMDPI AGBrain Sciences2076-34252021-07-0111794810.3390/brainsci11070948Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic ReviewNicola Acevedo0Peter Bosanac1Toni Pikoos2Susan Rossell3David Castle4Centre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, AustraliaSt. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, AustraliaCentre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, AustraliaCentre for Mental Health, Swinburne University of Technology, John Street, Melbourne, VIC 3122, AustraliaSt. Vincent’s Hospital Melbourne, 41 Victoria Parade, Melbourne, VIC 3065, AustraliaInvasive and noninvasive neurostimulation therapies for obsessive-compulsive and related disorders (OCRD) were systematically reviewed with the aim of assessing clinical characteristics, methodologies, neuroanatomical substrates, and varied stimulation parameters. Previous reviews have focused on a narrow scope, statistical rather than clinical significance, grouped together heterogenous protocols, and proposed inconclusive outcomes and directions. Herein, a comprehensive and transdiagnostic evaluation of all clinically relevant determinants is presented with translational clinical recommendations and novel response rates. Electroconvulsive therapy (ECT) studies were limited in number and quality but demonstrated greater efficacy than previously identified. Targeting the pre-SMA/SMA is recommended for transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). TMS yielded superior outcomes, although polarity findings were conflicting, and refinement of frontal/cognitive control protocols may optimize outcomes. For both techniques, standardization of polarity, more treatment sessions (>20), and targeting multiple structures are encouraged. A deep brain stimulation (DBS) ‘sweet spot’ of the striatum for OCD was proposed, and CBT is strongly encouraged. Tourette’s patients showed less variance and reliance on treatment optimization. Several DBS targets achieved consistent, rapid, and sustained clinical response. Analysis of fiber connectivity, as opposed to precise neural regions, should be implemented for target selection. Standardization of protocols is necessary to achieve translational outcomes.https://www.mdpi.com/2076-3425/11/7/948neurostimulationneuromodulationobsessive-compulsive disorder (OCD)neurocircuitryelectroconvulsive therapy (ECT)transcranial direct current stimulation (tDCS) |
| spellingShingle | Nicola Acevedo Peter Bosanac Toni Pikoos Susan Rossell David Castle Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review Brain Sciences neurostimulation neuromodulation obsessive-compulsive disorder (OCD) neurocircuitry electroconvulsive therapy (ECT) transcranial direct current stimulation (tDCS) |
| title | Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review |
| title_full | Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review |
| title_fullStr | Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review |
| title_full_unstemmed | Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review |
| title_short | Therapeutic Neurostimulation in Obsessive-Compulsive and Related Disorders: A Systematic Review |
| title_sort | therapeutic neurostimulation in obsessive compulsive and related disorders a systematic review |
| topic | neurostimulation neuromodulation obsessive-compulsive disorder (OCD) neurocircuitry electroconvulsive therapy (ECT) transcranial direct current stimulation (tDCS) |
| url | https://www.mdpi.com/2076-3425/11/7/948 |
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