Deep brain stimulation for obsessive-compulsive disorder: evolution of tractography-based targeting.

Area of Science:

• Neurosurgery
• Neurology
• Psychiatry

Background:

• Deep brain stimulation (DBS) in the anterior limb of the internal capsule (ALIC) shows promise for treating obsessive-compulsive disorder (OCD).
• Current ALIC DBS for OCD requires lengthy, unpredictable optimization due to anatomical variability and lack of consistent targeting.
• Improved targeting strategies are needed to enhance the scalability and clinical implementation of ALIC DBS for OCD.

Purpose of the Study:

• To demonstrate the evolution of prospective DBS targeting for OCD using patient-specific tractography.
• To develop a tractography-based predictive model for optimizing ALIC DBS parameters.
• To facilitate precision targeting for ALIC DBS in OCD treatment.

Main Methods:

• Initial targeting based on white matter maps and known cortical regions implicated in DBS for OCD.
• Generation of a common responder map from 6 OCD patients who responded to ALIC DBS.
• Prospective targeting of 7 new patients using the common responder map and development of a tractography-based predictive model.

Main Results:

• Targeting an optimal ALIC 'sweet spot' connected to vmPFC/OFC, vlPFC, and midbrain led to consistent OCD symptom reduction.
• 80% of patients achieved a clinically meaningful Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction (≥35%).
• Individualized tractography targeting improved OCD symptoms with minimal parameter adjustments and predicted Y-BOCS score reduction.

Conclusions:

• Patient-specific tractography enables clinically effective precision targeting for ALIC DBS in OCD.
• This approach enhances treatment predictability and scalability.
• Tractography-based models can further optimize future ALIC DBS targeting for OCD.