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

Ningfei Li,Bassam Al-Fatly,Juan A Barcia,Harith Akram,Eileen Joyce,Gavin J B Elias,Jens Kuhn,Astrid Kibleur,Ludvic Zrinzo,Svenja Treu,Andreas Horn,Juan Carlos Baldermann,Mircea Polosan,Alexandre Boutet,Andrea A Kühn,Bryan Strange,Veerle Visser-Vandewalle,Stephan Chabardes,Andres M Lozano

doi:10.1038/s41467-020-16734-3

Abstract

Multiple surgical targets for treating obsessive-compulsive disorder with deep brain stimulation (DBS) have been proposed. However, different targets may modulate the same neural network responsible for clinical improvement. We analyzed data from four cohorts of patients (N = 50) that underwent DBS to the anterior limb of the internal capsule (ALIC), the nucleus accumbens or the subthalamic nucleus (STN). The same fiber bundle was associated with optimal clinical response in cohorts targeting either structure. This bundle connected frontal regions to the STN. When informing the tract target based on the first cohort, clinical improvements in the second could be significantly predicted, and vice versa. To further confirm results, clinical improvements in eight patients from a third center and six patients from a fourth center were significantly predicted based on their stimulation overlap with this tract. Our results show that connectivity-derived models may inform clinical improvements across DBS targets, surgeons and centers. The identified tract target is openly available in atlas form.

Highlights

Multiple surgical targets for treating obsessive-compulsive disorder with deep brain stimulation (DBS) have been proposed
The superolateral branch of the medial forebrain bundle may connect most if not all surgical targets that were proposed for treatment of depression
In the first test cohort (Madrid; nucleus accumbens (NAcc) target; N = 8), improvement scores were taken after activating each of the four electrode contact pairs for 3 months, respectively

Summary

Introduction

Multiple surgical targets for treating obsessive-compulsive disorder with deep brain stimulation (DBS) have been proposed. The concept of modulating white-matter tracts (instead of gray matter nuclei) is certainly not new (and anterior capsulotomy was introduced in the ~1950s by Talairach and Leksell18), novel MRI technologies such as diffusion-weighted imagingbased tractography are increasingly used in functional neurosurgery in order to more deliberately target white-matter tracts. The concept of modulating white-matter tracts (instead of gray matter nuclei) is certainly not new (and anterior capsulotomy was introduced in the ~1950s by Talairach and Leksell18), novel MRI technologies such as diffusion-weighted imagingbased tractography are increasingly used in functional neurosurgery in order to more deliberately target white-matter tracts16 In this translational development, the Coenen and Mayberg groups should be explicitly mentioned, among others, for pioneering and rapidly translating the use of tractography to functional surgery since around 200910,14,15,19. The tract connected the ventral tegmental area and the prefrontal cortex and authors referred to it as the superolateral branch of the medial forebrain bundle

Methods

Results

Conclusion