Deep brain stimulation in obsessive–compulsive disorder targeted at the nucleus accumbens

The nucleus accumbens (NAc) was selected as a target for deep brain stimulation (DBS) in therapy-resistant obsessive–compulsive disorder (OCD) because of its predominant role in the corticostriatothalamocortical circuitry. To date, five efficacy studies have reported on NAc DBS for the treatment of OCD with a total of 34 subjects. These small studies (N = 2–16), with various designs, indicate an overall Yale–Brown Obsessive–Compulsive Scale score decrease ranging from 6.8 to 17.5 points. The average overall responder rate was ±50 %. The frequency of adverse events appears to be limited and generally reversible by readjusting the stimulation. Since our understanding of the mode of action of NAc DBS for the treatment of OCD is still limited, larger prospective studies including neuroimaging are needed to adequately estimate its true potential and to elucidate its underlying mechanism of action and optimal location of stimulation administration. We conclude that DBS targeted at the NAc is a promising and safe therapy for treatment-resistant OCD.