Unilateral Striatal Deep Brain Stimulation Improves Cognitive Control

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VCVS) can treat obsessive-compulsive disorder (OCD) and other psychiatric conditions. Yet, optimizing its clinical efficacy is a major challenge, often hindered by incomplete knowledge of how stimulation parameters and targets affect neural activity and behavior. VCVS DBS is thought to work in part by improving cognitive control, an important decision-making component that is impaired in OCD and other illnesses. The magnitude of this cognitive control enhancement was shown to be lateralized, with right-unilateral stimulation being the most effective. Prior work developed a preclinical model of VCVS DBS by leveraging the cognitive control construct, which can be measured in humans and rodents and is modulated by analogous brain circuits. However, this work did not address laterality effects observed in humans or examine left/right stimulation differences. These effects may be critical for maximizing therapeutic benefit while avoiding aversive outcomes. This study aimed to investigate lateralization in the rodent model, where bilateral stimulation of the mid-striatum was previously shown to improve cognitive control. Right- and left-unilateral stimulation reduced response times without changing accuracy, replicating the cognitive control improvement from bilateral stimulation. With computational modeling, we show that bilateral and unilateral stimulation modifies the same decision-making variables to drive this behavior change. We also establish that females have the same cognitive control improvement from stimulation as males. These findings increase our understanding of cognitive control circuits and strengthen the validity of the rodent model as a translational platform to study VCVS DBS's therapeutic mechanisms.