Can we modulate obsessive-compulsive networks with neuromodulation?

Neuromodulation techniques represent a network pathway-ori- ented treatment that can be considered as a promising tool in the achievement of “precision medicine” and a research domain criteria -based approach to treat several psychiatric disorders, including obsessive-compulsive disorder (OCD). Both repetitive transcranial magnetic stimulation (rTMS) tar- geting the pre-supplementary motor area (pre-SMA), deep TMS (dTMS) targeting the orbitofrontal cortex (OFC) and deep brain stimulation (DBS) targeting the nucleus accumbens (Nacc) and ventral capsule/ventral striatum (VC/VS) seem to be effective in improving obsessive-compulsive symptoms and to restore dysfunctional prefrontal-striatal and pre-motor cir- cuitries. Transcranial direct current stimulation (tDCS) effects on obsessive-compulsive symptoms have been less investi- gated, and the bulk of the available data is from case reports. Nevertheless, promising results are shown for cathodal stimu- lation of the OFC, while stimulation of the dorsolateral pre- frontal cortex (DLPFC) failed to improve symptomatology. The aim of this review is to discuss the effects of both invasive and non-invasive neuromodulation techniques in OCD, focusing on its core dysfunctional networks such as prefrontal-striatal and SMA networks.