A Unified Functional Network Target for Deep Brain Stimulation in Obsessive-Compulsive Disorder

Area of Science:

• Neuroscience
• Psychiatry
• Medical Imaging

Background:

• Intractable obsessive-compulsive disorder (OCD) treatment options include deep brain stimulation (DBS).
• Different DBS target sites have been proposed for OCD.
• The underlying functional brain networks modulated by these targets remain unclear.

Purpose of the Study:

• To investigate whether DBS effects in OCD patients are mediated by common or distinct functional brain networks.
• To identify shared and target-specific connectivity patterns predictive of clinical outcomes.
• To inform potential future neuromodulation targets for OCD.

Main Methods:

• Analysis of functional connectivity in 4 OCD patient cohorts (N=50) receiving DBS to anterior limb of internal capsule or subthalamic nucleus.
• Cross-validation of optimal connectivity profiles using leave-one-cohort-out and leave-one-patient-out designs.
• Utilized resting-state fMRI data from 1000 healthy participants to define functional connectivity.

Main Results:

• Optimal functional connectivity profiles exhibited both commonalities and differences between DBS target sites.
• Robust cross-prediction of clinical improvements across cohorts and targets suggested a shared network.
• Connectivity to anterior cingulate cortex, insula, and precuneus predicted outcomes regardless of stimulation target.

Conclusions:

• DBS for OCD modulates a common set of brain regions irrespective of the specific stimulation target.
• Identified brain regions provide a basis for developing novel or alternative neuromodulation targets for OCD.
• This study elucidates the network-level effects of DBS in OCD treatment.