Patient-specific connectomic models correlate with, but do not reliably predict, outcomes in deep brain stimulation for obsessive-compulsive disorder

Widge, Alik S.; Zhang, Fan; Gosai, Aishwarya; Papadimitrou, George; Wilson-Braun, Peter; Tsintou, Magdalini; Palanivelu, Senthil; Noecker, Angela M.; O’Donnell, Lauren J.; McLaughlin, Nicole; Greenberg, Benjamin D.; Makris, Nikolaos; Dougherty, Darin D.; Rathi, Yogesh

doi:10.1038/s41386-021-01199-9

Cited by 26 publications

(13 citation statements)

References 79 publications

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“…Liebrand, L.C., et al focused on the distance between DBS contacts and two fiber bundles and concluded that treatment response was better when the active contact was closer to the MFB and more distant to the anterior thalamic radiation (ATR) [ 30 ]. However, the research from Widge, A.S., et al demonstrated a negative result with this tract [ 41 ]. They compared the VTAs, and found that no tract reliably predicted continuous YBOCS improvement of VC/VS DBS.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder

Ruan

Wang

et al. 2022

Brain Sciences

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Obsessive-compulsive disorder (OCD) is a chronic and debilitating mental disorder. Deep brain stimulation (DBS) is a promising approach for refractory OCD patients. Research aiming at treatment outcome prediction is vital to provide optimized treatments for different patients. The primary purpose of this systematic review was to collect and synthesize studies on outcome prediction of OCD patients with DBS implantations in recent years. This systematic review (PROSPERO registration number: CRD42022335585) followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis) guidelines. The search was conducted using three different databases with the following search terms related to OCD and DBS. We identified a total of 3814 articles, and 17 studies were included in our review. A specific tract confirmed by magnetic resonance imaging (MRI) was predictable for DBS outcome regardless of implant targets, but inconsistencies still exist. Current studies showed various ways of successful treatment prediction. However, considering the heterogeneous results, we hope that future studies will use larger cohorts and more precise approaches for predictors and establish more personalized ways of DBS surgeries.

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder

Ruan

Wang

et al. 2022

Brain Sciences

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“…Building upon this work, Bouwens van der Vlis et al sought to find a unifying connectomic target for DBS by correlating outcomes data with tractography data in patients undergoing VC/VS DBS, and they found that the tract that was associated with best outcomes was a subpart of the ALIC that connects the prefrontal cortex with the STN and mediodorsal nucleus of the thalamus ( 147 ). In contrast to the other studies, Widge et al used patient-specific connectomics and statistical modeling in an attempt to predict treatment response, but they found that no statistical model could predict response ( 148 ). There is a clear need for more studies into defining the functional networks in OCD and using this information to inform patient-specific targeting.…”

Section: Methods Of Neuromodulationmentioning

confidence: 99%

Neuromodulation of OCD: A review of invasive and non-invasive methods

et al. 2022

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Early research into neural correlates of obsessive compulsive disorder (OCD) has focused on individual components, several network-based models have emerged from more recent data on dysfunction within brain networks, including the the lateral orbitofrontal cortex (lOFC)-ventromedial caudate, limbic, salience, and default mode networks. Moreover, the interplay between multiple brain networks has been increasingly recognized. As the understanding of the neural circuitry underlying the pathophysiology of OCD continues to evolve, so will too our ability to specifically target these networks using invasive and noninvasive methods. This review discusses the rationale for and theory behind neuromodulation in the treatment of OCD.

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“…The ultimate goal of all treatments is physiologic change. Multiple studies suggest that anatomic engagement alone cannot guarantee response 16,29,42 -target engagement means ensuring that stimulation is changing that tissue in the desired way. This is often referred to as "closed loop" DBS because programming is done in a closed feedback loop.…”

Section: From Trial and Error To Physiologic Biomarkersmentioning

confidence: 99%

Closed-Loop Deep Brain Stimulation for Psychiatric Disorders

Widge

2023

Harv Rev Psychiatry

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Deep brain stimulation (DBS) is a well-established approach to treating medication-refractory neurological disorders and holds promise for treating psychiatric disorders. Despite strong open-label results in extremely refractory patients, DBS has struggled to meet endpoints in randomized controlled trials. A major challenge is stimulation "dosing"-DBS systems have many adjustable parameters, and clinicians receive little feedback on whether they have chosen the correct parameters for an individual patient. Multiple groups have proposed closed loop technologies as a solution. These systems sense electrical activity, identify markers of an (un)desired state, then automatically deliver or adjust stimulation to alter that electrical state. Closed loop DBS has been successfully deployed in movement disorders and epilepsy. The availability of that technology, as well as advances in opportunities for invasive research with neurosurgical patients, has yielded multiple pilot demonstrations in psychiatric illness. Those demonstrations split into two schools of thought, one rooted in well-established diagnoses and symptom scales, the other in the more experimental Research Domain Criteria (RDoC) framework. Both are promising, and both are limited by the boundaries of current stimulation technology. They are in turn driving advances in implantable recording hardware, signal processing, and stimulation paradigms. The combination of these advances is likely to change both our understanding of psychiatric neurobiology and our treatment toolbox, though the timeframe may be limited by the realities of implantable device development.

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Patient-specific connectomic models correlate with, but do not reliably predict, outcomes in deep brain stimulation for obsessive-compulsive disorder

Abstract: doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.

Cited by 26 publications

References 79 publications

A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder

A Systematic Review of Treatment Outcome Predictors in Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder

Neuromodulation of OCD: A review of invasive and non-invasive methods

Closed-Loop Deep Brain Stimulation for Psychiatric Disorders

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