Abstract
Deep brain stimulation (DBS) in the brain region of the bed nucleus of the stria terminalis (BNST) is currently being investigated as a therapeutic treatment option for incapacitating and otherwise treatment-resistant obsessive–compulsive disorder (OCD). This therapeutic innovation started with DBS being investigated as an alternative treatment option for anterior capsulotomy for the treatment of OCD, and the BNST target evolved gradually from DBS in the anterior limbs of the internal capsule, because better therapeutic effects in OCD were observed with a more posterior location of the electrodes and a more medial position of the electrodes. The BNST is a highly complex structure at the crossroads of the corticostriatothalamocortical circuit involved in OCD and the amygdala. It plays a complementary role in regulation of physiological changes associated with chronic stress exposure and is considered an important component of anxiety circuitry. The BNST mediates slow-onset, lasting responses that frequently accompany sustained threats, and that may persist even after threat termination. It contributes in the coding of the appetitive outcome of a given situation. The reduction of OCD symptoms induced by DBS in the BNST suggests a role of this region in causing OCD.
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