Abstract
BackgroundDeep brain stimulation (DBS) is a new treatment option for patients with therapy-resistant obsessive–compulsive disorder (OCD). Approximately 60% of patients benefit from DBS, which might be improved if a biomarker could identify patients who are likely to respond. Therefore, we evaluated the use of preoperative structural magnetic resonance imaging (MRI) in predicting treatment outcome for OCD patients on the group- and individual-level. MethodsIn this retrospective study, we analyzed preoperative MRI data of a large cohort of patients who received DBS for OCD (n = 57). We used voxel-based morphometry to investigate whether grey matter (GM) or white matter (WM) volume surrounding the DBS electrode (nucleus accumbens (NAc), anterior thalamic radiation), and whole-brain GM/WM volume were associated with OCD severity and response status at 12-month follow-up. In addition, we performed machine learning analyses to predict treatment outcome at an individual-level and evaluated its performance using cross-validation. ResultsLarger preoperative left NAc volume was associated with lower OCD severity at 12-month follow-up (pFWE < 0.05). None of the individual-level regression/classification analyses exceeded chance-level performance. ConclusionsThese results provide evidence that patients with larger NAc volumes show a better response to DBS, indicating that DBS success is partly determined by individual differences in brain anatomy. However, the results also indicate that structural MRI data alone does not provide sufficient information to guide clinical decision making at an individual level yet.
Highlights
Deep brain stimulation (DBS) is a new treatment option for approximately 10% of patients with obsessive–compulsive disorder (OCD) who do not benefit from conventional pharmacological and psychological therapies (Denys et al, 2020)
While recent studies showed that treatment response might improve with diffusion magnetic resonance imaging (MRI) guided DBS targeting (Baldermann et al, 2019; Coenen et al, 2017; Liebrand et al, 2019), it is unlikely that all patients will become responders in the future
Patients were eligible for DBS if they did not previously respond to two 12-week trials with a selective serotonin reuptake in hibitors (SSRI) at maximum dosage, including augmentation with an atypical antipsychotic for 8 weeks, one 12-week trial of the maximum dosage clomipramine and cognitive behavioral therapy (CBT) at a center specialized in obses sive–compulsive disorder (OCD) (Denys et al, 2020)
Summary
Deep brain stimulation (DBS) is a new treatment option for approximately 10% of patients with obsessive–compulsive disorder (OCD) who do not benefit from conventional pharmacological and psychological therapies (Denys et al, 2020). Clinical predictors for DBS outcomes in OCD are scarce, with, e.g., an older age at onset of OCD being associated with better response on the group level (Alonso et al, 2015). These predictors cannot yet be used to determine which individual patients may or may not be suitable for DBS. DBS is a costly treatment with limited availability Selecting only those patients who are likely to benefit would increase DBS’s cost-effectiveness, since the likelihood of DBS being cost-effective is only 57% over the first two years (Ooms et al, 2017). The results indicate that structural MRI data alone does not provide sufficient information to guide clinical decision making at an individual level yet
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