Circuit-based neuromodulation for obsessive-compulsive disorder: a review of prior and emerging methods
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By
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Peter M. Lauro
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Charles F. Palmer
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Marshall M. Nambiar
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Ully Muller
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Liming Qiu
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Casey H. Halpern
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Katherine W. Scangos
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July 13, 2026
Clinical Scorecard: Neuromodulation Techniques Targeting Circuits in Obsessive-Compulsive Disorder: An Overview of Existing and Novel Approaches
At a Glance
| Category | Detail |
|---|
| Condition | Obsessive-Compulsive Disorder (OCD) |
| Key Mechanisms | Dysregulated cortico-striato-thalamo-cortical (CSTC) loops affecting cognitive and affective circuits. |
| Target Population | Individuals with OCD, particularly those who are refractory to first-line therapies. |
| Care Setting | Clinical settings utilizing neuromodulation techniques. |
Key Highlights
- OCD affects 2-3% of the US population.
- 30-40% of patients do not respond to first-line therapies like CBT and SRIs.
- Neurosurgical lesions provide insights into mapping symptoms to circuits.
- Emerging techniques include TMS, DBS, and FUS for targeted interventions.
- Future directions include closed-loop DBS and identifying symptom subtypes.
Guideline-Based Recommendations
Diagnosis
- Diagnosis of OCD based on clinical assessment of obsessions and compulsions.
Management
- Consider neuromodulation techniques for patients with refractory OCD.
Monitoring & Follow-up
- Monitor clinical response using the Yale-Brown Obsessive-Compulsive Scale (YBOCS).
Risks
- Invasive procedures may carry risks associated with neurosurgery and device implantation.
Patient & Prescribing Data
Patients with OCD, particularly those unresponsive to standard treatments.
Non-invasive and invasive neuromodulation techniques are being explored to improve outcomes.
Clinical Best Practices
- Utilize a circuit-based approach to understand OCD symptoms.
- Incorporate neuroimaging and electrophysiology in treatment planning.
- Consider adaptive neuromodulation strategies for symptom management.
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