Four Deep Brain Stimulation Targets for Obsessive-Compulsive Disorder: Are They Different?

Area of Science:

• Neuroscience
• Neurosurgery
• Psychiatry

Background:

• Treatment-resistant obsessive-compulsive disorder (OCD) is associated with corticobasal ganglia network dysfunction.
• Deep brain stimulation (DBS) targets subcortical areas to modulate these networks.
• Four primary DBS targets are used: anterior limb of the internal capsule, ventral striatum, subthalamic nucleus, and a midbrain target.

Purpose of the Study:

• To review and compare the anatomical connections of four deep brain stimulation targets for OCD.
• To evaluate the accuracy of diffusion magnetic resonance imaging (dMRI) tractography in mapping these connections.
• To delineate similarities and differences in connectivity across targets for improved therapeutic understanding.

Main Methods:

• Review of anatomical studies in nonhuman primates.
• Validation of dMRI tractography accuracy in nonhuman primates.
• Evaluation of human brain connectivity using dMRI tractography for each target.

Main Results:

• The four DBS targets generally share similar connections, primarily within the internal capsule.
• Each target exhibits unique connections, suggesting distinct circuit modulations.
• dMRI tractography accurately replicates primate anatomical connections in humans.

Conclusions:

• Understanding the nuanced connectivity of each DBS target is crucial for comparing treatment efficacy and mechanisms of action in OCD.
• Precise anatomical terminology for DBS targets is essential for consistent clinical and research comparisons.
• Further research into target-specific circuits can elucidate the mechanisms underlying DBS therapeutic outcomes.