Non-invasive neuromodulation in OCD: A clinical perspective

Amongst the most disabling psychiatric disorders, obsessive-compulsive disorder (OCD) is a prevalent, and chronic condition, burdened by an early onset, frequently in pre-adult age, and a pervasive limitation of patients interpersonal and occupational functioning.Nevertheless, as OCD treatment rarely results in complete remission, residual symptoms represent an on-going challenge for clinicians and researchers in the field. Non-invasive brain stimulation (rTMS/tDCS) has emerged as a promising tool to treat OCD resistant patients.Several randomized control trials using repeated transcranial magnetic stimulation (rTMS) to treat OCD have been published in the last 20 years but their results are inconclusive. We will try to present an updated review on the data on rTMS in OCD to provide a framework for its clinical use.tDCS has been more recently proposed as an useful add-on treatment for resistant patient. We will present the most updated data available on the treatment of OCD by tDCS and discuss the perspective in this field.DBS is as a reversible, non- ablative neurosurgical treatment option, approved by the FDA and the EMA for the treatment of refractory OCD patients. DBS clinical studies have permit a better insight on the physiopathology of OCD. Clinical experience with DBS in OCD suggest that brain stimulation should be implemented alongside intensive psychoeducation and psychotherapeutic interventions to reach optimal outcome.rTMS in treatment resistant OCD and related disorders: Where do we stand, where do we go? by Pr Bernardo Maria Dell’Osso; tDCS in anxiety and obsessive compulsive disorders by Dr Roberta Ferrucci; tDCS in SSRI resistant OCD? A randomized trial by Dr Rémy Bation; What can DBS teach us on OCD physiopathology and treatment? by Dr Anne-Hélène Clair.