Fig. 12.

Detailed Integration of subcortical projection pathways and the cortico-striato-thalamo-cortical (CSTC) loop theory in OCD. DBS potentially works largely over a modulation of the reward system (vtaPP/slMFB) and changes a top down pathological synchrony while SLS will largely inhibit affect system fibers (mdATR). DBS and SLS will have effect on both systems and act on both arms of the same CSTC loop. Both systems in combination have also been named the “salience network” (Peters et al., 2016). Legend: BS, brainstem; STN = subthalamic nucleus; VTA = ventral tegmental area; MDT=mediodorsal nucleus of thalamus; BNST = bed nucleus of stria terminalis, ITP=inferior thalamic peduncle, ALIC=anterior limb of internal capsule (DBS target), vc, ventral capsule (DBS target); PFC=prefrontal cortex; mdATR=medial anterior thalamic radiation; mdATRc= mdATR with cerebellar extension; vtaPP= VTA projection pathway; slMFB=superolateral medial forebrain bundle).