Personalized striatal targets for deep brain stimulation in obsessive-compulsive disorder

Area of Science:

• Neuroscience
• Neurosurgery
• Psychiatry

Background:

• Obsessive-compulsive disorder (OCD) is a heterogeneous condition, suggesting that a one-size-fits-all approach to deep brain stimulation (DBS) may not be optimal.
• Current DBS targets for OCD are fixed and may not account for individual differences in symptom presentation.

Purpose of the Study:

• To determine if the optimal DBS target for OCD is patient-specific and correlates with symptom content.
• To investigate if functional neuroimaging and structural connectivity can predict the best DBS target for individual OCD patients.

Main Methods:

• A randomized, double-blind study involving 7 OCD patients.
• Symptom characterization via clinical interview and functional MRI during symptom provocation.
• DBS electrode placement along a striatal axis, with stimulation at each contact.
• Probabilistic tractography to analyze prefrontal projections and activated tissue overlap.

Main Results:

• Six of seven patients responded to DBS, with significant symptom reduction.
• The optimal stimulation contact varied, located in the caudate for 4 patients and the nucleus accumbens for 2.
• The best contact location was predicted by combining functional MRI data and prefronto-striatal connectivity.

Conclusions:

• This study demonstrates a link between individual symptom profiles, brain connectivity, and optimal DBS target location in OCD.
• Findings support the development of personalized, content-specific DBS targets for improved OCD treatment outcomes.