Invasive brain mapping identifies personalized therapeutic neuromodulation targets that suppress OCD network activity

Area of Science:

• Neuroscience
• Neurosurgery
• Psychiatry

Background:

• Deep brain stimulation (DBS) is used for severe, refractory obsessive-compulsive disorder (OCD).
• Outcomes vary significantly depending on the anatomical targets used.
• Limitations necessitate novel approaches for personalized treatment.

Purpose of the Study:

• To develop and validate an invasive brain mapping paradigm for personalized neuromodulation in refractory OCD.
• To identify specific targets within the cortico-striato-thalamo-cortical circuit for optimal symptom reduction.
• To characterize the downstream circuit effects of personalized stimulation.

Main Methods:

• Developed an invasive brain mapping paradigm involving electrode implantation across the OCD circuit.
• Performed extensive stimulation mapping over multiple days to identify personalized therapeutic targets.
• Characterized downstream circuit effects, including suppression of high-frequency activity in connected cortical regions.

Main Results:

• Identified two specific targets within the right ventral capsule (VC) that acutely reduced OCD symptoms.
• Prolonged VC stimulation suppressed high-frequency activity in the orbitofrontal and cingulate cortex.
• These connected cortical regions were identified as key nodes encoding OCD symptom severity.

Conclusions:

• This study provides the first proof-of-concept for invasive brain mapping to guide personalized neuromodulation in refractory OCD.
• A novel personalized, multi-site neuromodulation approach using VC targets demonstrated a rapid therapeutic response.
• This approach offers a promising strategy for optimizing DBS outcomes in severe, treatment-resistant OCD.