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

Nat Commun. 2020 Jul 3;11(1):3364. doi: 10.1038/s41467-020-16734-3.

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.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Connectome / psychology*
  • Deep Brain Stimulation / instrumentation
  • Deep Brain Stimulation / methods*
  • Electrodes, Implanted
  • Female
  • Follow-Up Studies
  • Humans
  • Internal Capsule / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Models, Neurological*
  • Nerve Net / physiopathology
  • Nucleus Accumbens / physiopathology
  • Obsessive-Compulsive Disorder / physiopathology
  • Obsessive-Compulsive Disorder / psychology
  • Obsessive-Compulsive Disorder / therapy*
  • Postoperative Period
  • Preoperative Period
  • Prognosis
  • Retrospective Studies
  • Subthalamic Nucleus / physiopathology
  • Tomography, X-Ray Computed
  • Treatment Outcome
  • Young Adult