Personalized striatal targets for deep brain stimulation in obsessive-compulsive disorder

Nombela, Cristina; Avecillas-Chasín, Josué M; Arza, Rocío; García-Albea, Julia; Pineda-Pardo, José A.; Reneses, Blanca; Strange, Bryan A.

doi:10.1016/j.brs.2018.12.226

Cited by 69 publications

(86 citation statements)

References 41 publications

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“…Patients in all cohorts were of similar age with a similar Y-BOCS score at baseline and comparable Y-BOCS improvement scores (Table 1). In the first test cohort (Madrid; NAcc target; N = 8), improvement scores were taken after activating each of the four electrode contact pairs for 3 months, respectively (following the clinical protocol as described in 39 ).…”

Section: Resultsmentioning

confidence: 99%

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Baldermann

Kibleur

et al. 2019

Preprint

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Multiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with deep brain stimulation (DBS). However, different targets may modulate the same neural network responsible for clinical improvement. Here we analyzed data from four cohorts of OCD patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens (NAcc) or the subthalamic nucleus (STN). Fiber tracts that were predominantly connected to electrodes in good or poor DBS responders were isolated from a normative structural connectome and assigned a predictive value. Strikingly, the same fiber bundle was related to treatment response when independently analyzing two large training cohorts that targeted either ALIC or STN. This discriminative tract is a subsection of the ALIC and connects frontal regions (such as the dorsal anterior cingulate, dACC, and ventral prefrontal, vlPFC, cortices to the STN). When informing the tract solely based on one cohort (e.g. ALIC), clinical improvements in the other (e.g. STN)could be significantly predicted, and vice versa. Finally, clinical improvements of eight patients from a third center with electrodes in the NAcc and six patients from a fourth center in which electrodes had been implanted in both STN and ALIC were significantly predicted based on this novel tract-based DBS target. Results suggest a functional role of a limbic hyperdirect pathway that projects from dACC and vlPFC to anteriomedial STN. Obsessivecompulsive symptoms seem to be tractable by modulating the specific bundle isolated here.Our results show that connectivity-derived improvement models can inform clinical improvement across DBS targets, surgeons and centers. The identified tract is now threedimensionally defined in stereotactic standard space and will be made openly available.

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Section: Resultsmentioning

confidence: 99%

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Baldermann

Kibleur

et al. 2019

Preprint

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“…Every trial reported lower mean Y-BOCS severity in the on condition relative to the off condition as assessed immediately following the stimulation period, though this difference only reached statistical significance in three of the six studies that employed significance testing (one study did not use significance testing due to a sample size of 4 patients [23]). Although three of these trials did not demonstrate statistically significant superiority of active vs. sham DBS, they all showed lower Y-BOCS scores in the active groups, and significant declines in Y-BOCS scores during the open phases of the trial (see 'Long term clinical significance' section) [24,26,27]. The three studies with relatively larger sample sizes (ns = 14-17) showed significant differences between sham and active DBS settings (differences in average post-DBS Y-BOCS scores of 8, 9, and 11 points) [13,14,25].…”

Section: Efficacy Compared With Sham Stimulationmentioning

confidence: 98%

“…The main outcome, OCD severity, was assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) [22] in every trial. Six trials followed a randomized crossover design, with patients randomly assigned to 'on-off' or 'off-on' sequences of stimulation [13,14,[23][24][25][26]. One trial used a staggered-onset design [27].…”

Section: Efficacy Compared With Sham Stimulationmentioning

confidence: 99%

Improving long term patient outcomes from deep brain stimulation for treatment-refractory obsessive-compulsive disorder

Guzick

Hunt

Bijanki

et al. 2019

Expert Review of Neurotherapeutics

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Introduction: Deep brain stimulation (DBS) has emerged as an effective treatment for patients with severe treatment-refractory obsessive-compulsive disorder (OCD). Over the past two decades, several clinical trials with multiple years of follow-up have shown that DBS offers long-term symptom relief for individuals with severe OCD, though a portion of patients do not achieve an adequate response. Areas covered: This review sought to summarize the literature on the efficacy and long-term effectiveness of DBS for OCD, and to identify strategies that have the potential to improve treatment outcomes. Expert opinion: Although this literature is just emerging, a small number of DBS enhancement strategies have shown promising initial results. More posterior targets along the striatal axis and at the bed nucleus of the stria terminalis appear to offer greater symptom relief than more anterior targets. Research is also beginning to demonstrate the feasibility of maximizing treatment outcomes with target selection based on neural activation patterns during symptom provocation and clinical presentation. Finally, integrating DBS with post-surgery exposure and response prevention therapy appears to be another promising approach. Definitive conclusions about these strategies are limited by a low number of studies with small sample sizes that will require multisite replication.

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“…Another study examined a personalized technique for DBS targeting in OCD . A prospective, randomized, double‐blinded study was conducted of 7 patients who underwent bilateral DBS of the striatum to strategically reach projections from the PFC.…”

Section: Obsessive‐compulsive Disordermentioning

confidence: 99%

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

et al. 2020

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A BS TRACT: DBS is an effective neuromodulatory therapy that has been applied in various conditions, including PD, essential tremor, dystonia, Tourette syndrome, and other movement disorders. There have also been recent examples of applications in epilepsy, chronic pain, and neuropsychiatric conditions. Innovations in neuroimaging technology have been driving connectomics, an emerging whole-brain network approach to neuroscience. Two rising techniques are functional connectivity profiling and structural connectivity profiling. Functional connectivity profiling explores the operational relationships between multiple regions of the brain with respect to time and stimuli. Structural connectivity profiling approximates physical connections between different brain regions through reconstruction of axonal fibers. Through these techniques, complex relationships can be described in various disease states, such as PD, as well as in response to therapy, such as DBS. These advances have expanded our understanding of human brain function and have provided a partial in vivo glimpse into the underlying brain circuits underpinning movement and other disorders. This comprehensive review will highlight the contemporary concepts in brain connectivity as applied to DBS, as well as introduce emerging considerations in movement disorders.

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Personalized striatal targets for deep brain stimulation in obsessive-compulsive disorder

Cited by 69 publications

References 41 publications

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Improving long term patient outcomes from deep brain stimulation for treatment-refractory obsessive-compulsive disorder

A Comprehensive Review of Brain Connectomics and Imaging to Improve Deep Brain Stimulation Outcomes

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