Nucleus Accumbens Stimulation Modulates Inhibitory Control by Right Prefrontal Cortex Activation in Obsessive-Compulsive Disorder

Abstract

Inhibitory control is considered a compromised cognitive function in obsessive-compulsive (OCD) patients and likely linked to corticostriatal circuitry disturbances. Here, 9 refractory OCD patients treated with deep brain stimulation (DBS) were evaluated to address the dynamic modulations of large-scale cortical network activity involved in inhibitory control after nucleus accumbens (NAc) stimulation and their relationship with cortical thickness. A comparison of DBS “On/Off” states showed that patients committed fewer errors and exhibited increased intraindividual reaction time variability, resulting in improved goal maintenance abilities and proactive inhibitory control. Visual P3 event-related potentials showed increased amplitudes during Go/NoGo performance. Go and NoGo responses increased cortical activation mainly over the right inferior frontal gyrus and medial frontal gyrus, respectively. Moreover, increased cortical activation in these areas was equally associated with a higher cortical thickness within the prefrontal cortex. These results highlight the critical role of NAc DBS for preferentially modulating the neuronal activity underlying sustained speed responses and inhibitory control in OCD patients and show that it is triggered by reorganizing brain functions to the right prefrontal regions, which may depend on the underlying cortical thinning. Our findings provide updated structural and functional evidence that supports critical dopaminergic-mediated frontal-striatal network interactions in OCD.

Predictors of deep brain stimulation (DBS) response in patients with obsessive compulsive disorder (OCD): a systematic review and meta-analysis

“…Out of the 35 included studies, there were 8 randomised controlled trials [16][17][18][19][20][21][22][23] and 27 non-randomised studies. 8, Using the ROBINS-I tool for non-randomised studies (n=27), 4 were considered to have a 'low' risk of bias, 26,32,48,49 15 'moderate' risk of bias, ,24,27,29,30,34,35,36,38,39,40,42-46 7 'serious' risk of bias 8,25,31,33,37,41,47 and 1 'critical' risk of bias 28 (Supplementary Figure 1). Using the RoB-2 tool for randomised controlled trials (n=8), 5 were considered to have a 'low' risk of bias [17][18][19]21,22 whereas 3 were deemed to have 'some concerns' 16,20,23 (Supplementary Figure 2).…”

“…Of the included literature, 18 studies [16][17][18]21,25,26,[28][29][30]33,34,37,38,40,[43][44][45]49 examined the potential role of OCD symptom predominance in determining DBS response. The primary symptoms highlighted were contamination, checking, and intrusive thoughts.…”