Circuit-based Evidence and Practice of Neuromodulation for Obsessive-Compulsive Disorder: Towards the Optimal Neural Circuit

Obsessive-Compulsive Disorder (OCD) is characterized by persistent intrusive thoughts and compulsive behaviors that are often resistant to traditional treatment methods such as medication and psychotherapy. Neuromodulation, targeting specific brain circuits, has emerged as a promising alternative for treating refractory OCD. This study aims to synthesize the effectiveness of various neuromodulation techniques, focusing particularly on their impact on neural circuitry based on existing symptom and treatment taxonomies. Through a systematic search of major databases, randomized controlled trials of both invasive and non-invasive neuromodulation techniques targeting different brain circuits were analyzed. The primary outcome was measured by changes in the Yale-Brown Obsessive-Compulsive Scale. The comprehensive search included 868 patients and demonstrated significant improvement in OCD symptoms through neuromodulation. The most substantial improvements were observed when targeting the fronto-limbic circuit. Additional significant symptom relief was noted in interventions affecting the sensorimotor and ventral affective circuits, with invasive methods outperforming non-invasive ones. In addition, a detailed case study of Deep Brain Stimulation from our center targeting the subthalamic nucleus, nucleus accumbens, and anterior limb of the internal capsule (ALIC) highlighted substantial symptom relief by specifically modulating the fronto-limbic circuit (targeting ALIC), aligning with the results of the meta-analysis. The findings underline the importance to tailor neuromodulation treatments to individual patients’ needs on the circuitry basis, optimizing outcomes in OCD management.