A unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Abstract

Multiple surgical targets for treating obsessive-compulsive disorder with deep brain stimulation (DBS) have been proposed. However, different targets may modulate the same neural network responsible for clinical improvement. We analyzed data from four cohorts of patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens or the subthalamic nucleus (STN). The same fiber bundle was associated with optimal clinical response in cohorts targeting either structure. This bundle connected frontal regions to the STN. When informing the tract target based on the first cohort, clinical improvements in the second could be significantly predicted, and vice versa. To further confirm results, clinical improvements in eight patients from a third center and six patients from a fourth center were significantly predicted based on their stimulation overlap with this tract. Our results show that connectivity-derived models may inform clinical improvements across DBS targets, surgeons and centers. The identified tract target is openly available in atlas form.

Opportunities of connectomic neuromodulation

“…This concept was first used to identify connections that co-varied with improvement in Parkinson’s symptoms following DBS to the STN ( Horn et al,2017 ). Since this time, the same approach has been used to further investigate DBS-induced improvements in Parkinson’s Disease ( Horn et al, 2017 ; Joutsa et al, 2018a ), as well as Dystonia ( Corp et al, 2019 ; Okromelidze et al, 2020 ), Essential Tremor ( Al-Fatly et al,2019 ), epilepsy ( Middlebrooks et al, 2018a )and OCD ( Baldermann et al, 2019b ; Li et al, 2020 )( Fig. 3 ).…”

“…As mentioned above, studies have begun to investigate the relationship between clinical improvement following DBS and connectivity between the active stimulation site and the rest of the brain ( Akram et al, 2018 ; 2017 ; Al-Fatly et al, 2019 ; Baldermann et al, 2019b ; Calabrese et al, 2015b ; Fernandes et al, 2015 ; Horn et al, 2017 ; Irmen et al, 2019 ; Joutsa et al, 2018a ; Li et al, 2020 ; Vanegas Arroyave et al, 2016 ).…”

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

“…DBS has several appealing features, such as reversibility and titratability, however it requires an open surgical procedure, with intracranial access and attendant surgical risk, as well as permanent implantation of the stimulating electrodes and pulse generator. In addition, despite promising early reports, recent trials have been inconclusive in terms of the benefit [7][8][9][10][11] . Rapid advances in imaging and surgical technology has led to a revival in lesional procedures 12 .…”

Deep brain stimulation for psychiatric disorders: From focal brain targets to cognitive networks

“…The availability of open-source software to perform similar activation mapping ( Horn and Kühn 2015 ) could make such techniques widely available, especially given the proliferation of high-quality tractography scanners/ software spurred by the Human Connectome Project. Other groups have found similar tractographic predictors of efficacy in VC/VS DBS for OCD ( Hartmann et al 2016 , Baldermann et al 2019 , Li et al 2020 ) and mapped the anatomic variation of that target ( Makris et al 2016 ).…”