Tractography-based DBS lead repositioning improves outcome in refractory OCD and depression
Genevieve Basich-Pease1,2, Natalya Slepneva1,2, Adam C Frank1,2,3
1Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
Frontiers in Human Neuroscience
|February 22, 2024
Summary
Deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) and depression can be improved by precise lead placement. Tractography-guided repositioning enhanced patient outcomes, demonstrating its clinical utility.
Area of Science:
- Neurosurgery
- Neuromodulation
- Neuroimaging
Background:
- Deep brain stimulation (DBS) targeting the anterior limb of the internal capsule (ALIC) is a treatment for refractory obsessive-compulsive disorder (OCD) and depression.
- Treatment outcomes for ALIC DBS are variable, potentially due to suboptimal lead placement.
- Emerging evidence suggests specific white matter tracts within the ALIC correlate with improved therapeutic benefits.
Observation:
- A patient with refractory OCD and depression initially showed only modest improvement after ALIC DBS.
- The patient underwent unilateral DBS lead repositioning guided by tractography, targeting specific white matter pathways connecting the prefrontal cortex to the mediodorsal thalamus.
Findings:
- Diffusion imaging confirmed successful tractography could be performed even with DBS leads in situ, both pre- and post-repositioning.
- Following repositioning into tracts predicted to be beneficial, the patient achieved OCD responder status and remission of depressive symptoms.
Implications:
- This case highlights the potential of tractography to guide DBS lead repositioning for optimizing therapeutic outcomes in OCD and depression.
- Tractography-guided lead adjustment may improve efficacy and patient response rates in neuromodulation therapies.
- This approach offers a method for refining surgical targeting in DBS to enhance clinical results.
