Invasive Mapping of Therapeutic Response to Deep Brain Stimulation for Obsessive Compulsive Disorder
Poster No:
8
Submission Type:
Late-Breaking Abstract Submission
Authors:
Audrey Kist1, John Alvarez1, Alexandra Tremblay-McGaw1, Nathalie Becker1, Anusha Allawala1, Jolene Fan1, Ankit Khambati1, Tenzin Norbu1, Leo Sugrue1, Kristin Sellers1, Philip Starr1, Andrew Krystal2, Edward Chang1, A. Moses Lee1
Institutions:
1UCSF, San Francisco, CA, 2University of California San Francisco, San Francisco, CA
First Author:
Co-Author(s):
Introduction:
Multiple deep brain stimulation (DBS) targets have been used to treat OCD, with moderate degrees of success (Gadot et al., 2022; Raviv et al., 2020; Vicheva et al., 2020). The variability in outcomes may be related to heterogeneity within OCD-related circuitry across individuals. To overcome these challenges, we performed invasive brain mapping with stereo-encephalography (sEEG) to identify personalized DBS targets to treat severe, refractory OCD. Here, we present results from our first participant.
Methods:
During the invasive brain mapping, 12 sEEG leads were implanted in components of the cortico-striato-thalamo-cortical circuit implicated in OCD. Implanted regions include orbitofrontal cortex (OFC) (Carmi et al., 2019; Nauczyciel et al., 2014), anterior cingulate cortex (ACC) (De Ridder et al., 2017), ventral capsule (VC – nucleus accumbens NAc, bed nucleus of the stria terminalis BNST) (Denys et al., 2020; Luyten et al., 2016), and subthalamic nucleus (Haber et al., 2023; Mallet et al., 2019). Subsequently, extensive stimulation mapping was performed to identify network nodes and targets that reduced symptoms, and intracranial recordings were performed to track electrophysiological response to targets stimulation. Symptoms were measured on self-reported Visual Analog Scales: Obsessions, Compulsions, OCD-Related Distress, Anxiety, Depression, and Energy.
Results:
With double-blind, sham-controlled repeated testing, we identified two sites within the right VC eliciting a therapeutic response. R VC/NAc and R VC/BNST stimulation elicited fast, acute improvement in OCD symptoms (best target: R VC/NAc, mean reduction of 32% of the obsessive-compulsive score within 20-minute stimulation recordings, p-value = 0.018 compared to sham stimulation, permutation test n=10,000). Stimulation of these 2 sites specifically decreased High Frequency Activity ( HFA, 30-95 Hz) in the right OFC, which was not the case when stimulating other targets. Additionally, stimulation of the second-best target RVC/BNST elicited an HFA decrease in the right ACC. Evoked potential mapping showed that outward cortical connectivity of these targets strongly correlates with cortical suppression. Diffusion tensor imaging showed that these targets were extensively connected to cortical areas of interest.
·sEEG invasive brain mapping of therapeutical response to DBS in OCD
·Connectivity Mapping for best therapeutical DBS targets in OCD
Conclusions:
This data suggests that it is possible to elicit fast OC-specific symptoms alleviation using DBS. Here, we show that best targets stimulation decreases cortical high frequency activity in the right OFC. Based upon these results, we propose that DBS is mediating its therapeutic benefit by interfering with thalamo-cortical communication within circuits encoding OCD symptoms.
Brain Stimulation:
Deep Brain Stimulation 1
Invasive Stimulation Methods Other
Disorders of the Nervous System:
Psychiatric (eg. Depression, Anxiety, Schizophrenia) 2
Keywords:
Obessive Compulsive Disorder
Psychiatric Disorders
Other - sEEG
1|2Indicates the priority used for review
Abstract Information
By submitting your proposal, you grant permission for the Organization for Human Brain Mapping (OHBM) to distribute your work in any format, including video, audio print and electronic text through OHBM OnDemand, social media channels, the OHBM website, or other electronic publications and media.
The Open Science Special Interest Group (OSSIG) is introducing a reproducibility challenge for OHBM 2025. This new initiative aims to enhance the reproducibility of scientific results and foster collaborations between labs. Teams will consist of a “source” party and a “reproducing” party, and will be evaluated on the success of their replication, the openness of the source work, and additional deliverables. Click here for more information. Propose your OHBM abstract(s) as source work for future OHBM meetings by selecting one of the following options:
Please indicate below if your study was a "resting state" or "task-activation” study.
Healthy subjects only or patients (note that patient studies may also involve healthy subjects):
Was this research conducted in the United States?
Are you Internal Review Board (IRB) certified? Please note: Failure to have IRB, if applicable will lead to automatic rejection of abstract.
Were any human subjects research approved by the relevant Institutional Review Board or ethics panel? NOTE: Any human subjects studies without IRB approval will be automatically rejected.
Were any animal research approved by the relevant IACUC or other animal research panel? NOTE: Any animal studies without IACUC approval will be automatically rejected.
Please indicate which methods were used in your research:
Provide references using APA citation style.
De Ridder, D. et al. (2017). Anterior Cingulate Implant for Obsessive-Compulsive Disorder. World Neurosurgery, 97, 754.e7-754.e16.
Denys, D. et al. (2020). Efficacy of Deep Brain Stimulation of the Ventral Anterior Limb of the Internal Capsule for Refractory Obsessive-Compulsive Disorder: A Clinical Cohort of 70 Patients. The American Journal of Psychiatry, 177(3), Article 3.
Gadot, R. et al. (2022). Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: Systematic review and meta-analysis. Journal of Neurology, Neurosurgery & Psychiatry, 93(11), 1166–1173.
Haber, S. N. et al. (2023). The Rostral Zona Incerta: A Subcortical Integrative Hub and Potential Deep Brain Stimulation Target for Obsessive-Compulsive Disorder. Biological Psychiatry, 93(11), 1010–1022.
Luyten, L. et al. (2016). Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder. Molecular Psychiatry, 21(9), Article 9.
Mallet, L. et al (2019). Long-term effects of subthalamic stimulation in Obsessive-Compulsive Disorder: Follow-up of a randomized controlled trial. Brain Stimulation, 12(4), Article 4.