Non-invasive neurostimulation in OCD – implications for widescale application.

Abstract Brain-imaging findings implicate aberrant cortico-striatal neurocircuitry in the underlying pathology of OCD, so representing a potential treatment target. Ablative neurosurgery or deep brain (invasive) stimulation (DBS) tracts nodes within this circuitry is sometimes found to improve possibly by enhancing information-processing functions. Non-invasive neurostimulation, targeting superficial cortical circuitry, safer and more acceptable alternative, with for scaling up applying larger patient population, earlier course illness. Repetitive transcranial magnetic (rTMS) form neuromodulation studied most OCD. The orbitofrontal cortex (OFC), dorsolateral prefrontal supplementary motor area (SMA) have been identified as promising targets. effect those not resistant SSRI failing respond only one trial. Thus, r-TMS may be best implemented care pathway. rTMS also relatively costly, involves specialist technical equipment staff, cannot delivered patients’ homes. Transcranial direct current (tDCS) low-amplitude (1-3mA) electric via electrodes placed on scalp. Compared rTMS, tDCS tends electrically modulate diffuse area, but it could represent preferable option patients common mental disorders such cheaper, portable, simple safe use. In recent randomised controlled feasibility study, L-OFC represented optimal target based clinical changes. Further investigation OCD warranted, determine protocol, longer-term effectiveness brain-based mechanisms effect. If efficacy substantiated, home-based approaches rational next step. Disclosure Interest N. Fineberg Grant / Research support from: past three years I received research funding from NIHR, COST Orchard; . additionally financial attend meetings British Association Psychopharmacology, European College Neuropsychopharmacology, Royal Psychiatrists, International World Psychiatric Association, Forum Mood Anxiety Disorders, American Neuropsychopharmacology. various pharmaceutical companies into role SSRIs other forms medication treatments OCD., Consultant of: payment expert advisory work psychopharmacology Medicines Healthcare Products Regulatory Agency, royalties Oxford University Press an honorarium Elsevier editorial work., Paid Instructor lectures Global Mental Health Academy.