Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites

Garance M Meyer; Barbara Hollunder; Ningfei Li; Konstantin Butenko; Till A Dembek; Lauren Hart; Cristina Nombela; Philip Mosley; Harith Akram; Nicola Acevedo; Benjamin M Borron; Tina Chou; Juan Pablo Castaño Montoya; Bryan Strange; Juan A Barcia; Himanshu Tyagi; David J Castle; Andrew H Smith; Ki Sueng Choi; Brian H Kopell; Helen S Mayberg; Sameer A Sheth; Wayne Goodman; Albert F G Leentjens; R Mark Richardson; Susan L Rossell; Peter Bosanac; G Rees Cosgrove; Jens Kuhn; Veerle Visser-Vandewalle; Martijn Figee; Darin D Dougherty; Shan H Siddiqi; Ludvic Zrinzo; Eileen Joyce; Juan Carlos Baldermann; Michael D Fox; Clemens Neudorfer; Andreas Horn

doi:10.1016/j.biopsych.2023.12.010

Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites

Garance M Meyer^*, Barbara Hollunder, Ningfei Li, Konstantin Butenko, Till A Dembek, Lauren Hart, Cristina Nombela, Philip Mosley, Harith Akram, Nicola Acevedo, Benjamin M Borron, Tina Chou, Juan Pablo Castaño Montoya, Bryan Strange, Juan A Barcia, Himanshu Tyagi, David J Castle, Andrew H Smith, Ki Sueng Choi, Brian H KopellHelen S Mayberg, Sameer A Sheth, Wayne Goodman, Albert F G Leentjens, R Mark Richardson, Susan L Rossell, Peter Bosanac, G Rees Cosgrove, Jens Kuhn, Veerle Visser-Vandewalle, Martijn Figee, Darin D Dougherty, Shan H Siddiqi, Ludvic Zrinzo, Eileen Joyce, Juan Carlos Baldermann, Michael D Fox, Clemens Neudorfer, Andreas Horn

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: Deep brain stimulation (DBS) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Several stimulation targets have been used, mostly in and around the anterior limb of the internal capsule and ventral striatum (VC/VS). However, the precise target within this region remains a matter of debate. METHODS: Here, we retrospectively studied a multicenter cohort of 82 patients that underwent DBS of the VC/VS and mapped optimal stimulation sites in this region. RESULTS: DBS sweet-spot mapping performed on a discovery set of 58 patients revealed two optimal stimulation sites associated with improvements on the Yale-Brown Obsessive-Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract, and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from two additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements of depression. CONCLUSIONS: Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.

Original language	English
Pages (from-to)	101-113
Number of pages	13
Journal	Biological Psychiatry
Volume	96
Issue number	2
Early online date	21 Dec 2023
DOIs	https://doi.org/10.1016/j.biopsych.2023.12.010
Publication status	Published - 15 Jul 2024

Keywords

Anterior Limb of the Internal Capsule
Bed Nucleus of the Stria Terminalis
Deep Brain Stimulation
Obsessive-Compulsive Disorder
Sweet-spot
Ventral Striatum

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Meyer, G. M., Hollunder, B., Li, N., Butenko, K., Dembek, T. A., Hart, L., Nombela, C., Mosley, P., Akram, H., Acevedo, N., Borron, B. M., Chou, T., Castaño Montoya, J. P., Strange, B., Barcia, J. A., Tyagi, H., Castle, D. J., Smith, A. H., Choi, K. S., ... Horn, A. (2024). Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites. Biological Psychiatry, 96(2), 101-113. https://doi.org/10.1016/j.biopsych.2023.12.010

@article{f8779bfb9f414df69010f195fc838d22,

title = "Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites",

abstract = "BACKGROUND: Deep brain stimulation (DBS) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Several stimulation targets have been used, mostly in and around the anterior limb of the internal capsule and ventral striatum (VC/VS). However, the precise target within this region remains a matter of debate. METHODS: Here, we retrospectively studied a multicenter cohort of 82 patients that underwent DBS of the VC/VS and mapped optimal stimulation sites in this region. RESULTS: DBS sweet-spot mapping performed on a discovery set of 58 patients revealed two optimal stimulation sites associated with improvements on the Yale-Brown Obsessive-Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract, and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from two additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements of depression. CONCLUSIONS: Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.",

keywords = "Anterior Limb of the Internal Capsule, Bed Nucleus of the Stria Terminalis, Deep Brain Stimulation, Obsessive-Compulsive Disorder, Sweet-spot, Ventral Striatum",

author = "Meyer, {Garance M} and Barbara Hollunder and Ningfei Li and Konstantin Butenko and Dembek, {Till A} and Lauren Hart and Cristina Nombela and Philip Mosley and Harith Akram and Nicola Acevedo and Borron, {Benjamin M} and Tina Chou and {Casta{\~n}o Montoya}, {Juan Pablo} and Bryan Strange and Barcia, {Juan A} and Himanshu Tyagi and Castle, {David J} and Smith, {Andrew H} and Choi, {Ki Sueng} and Kopell, {Brian H} and Mayberg, {Helen S} and Sheth, {Sameer A} and Wayne Goodman and Leentjens, {Albert F G} and Richardson, {R Mark} and Rossell, {Susan L} and Peter Bosanac and Cosgrove, {G Rees} and Jens Kuhn and Veerle Visser-Vandewalle and Martijn Figee and Dougherty, {Darin D} and Siddiqi, {Shan H} and Ludvic Zrinzo and Eileen Joyce and Baldermann, {Juan Carlos} and Fox, {Michael D} and Clemens Neudorfer and Andreas Horn",

year = "2024",

month = jul,

day = "15",

doi = "10.1016/j.biopsych.2023.12.010",

language = "English",

volume = "96",

pages = "101--113",

journal = "Biological Psychiatry",

issn = "0006-3223",

publisher = "Elsevier Science",

number = "2",

}

Meyer, GM, Hollunder, B, Li, N, Butenko, K, Dembek, TA, Hart, L, Nombela, C, Mosley, P, Akram, H, Acevedo, N, Borron, BM, Chou, T, Castaño Montoya, JP, Strange, B, Barcia, JA, Tyagi, H, Castle, DJ, Smith, AH, Choi, KS, Kopell, BH, Mayberg, HS, Sheth, SA, Goodman, W, Leentjens, AFG, Richardson, RM, Rossell, SL, Bosanac, P, Cosgrove, GR, Kuhn, J, Visser-Vandewalle, V, Figee, M, Dougherty, DD, Siddiqi, SH, Zrinzo, L, Joyce, E, Baldermann, JC, Fox, MD, Neudorfer, C & Horn, A 2024, 'Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites', Biological Psychiatry, vol. 96, no. 2, pp. 101-113. https://doi.org/10.1016/j.biopsych.2023.12.010

TY - JOUR

T1 - Deep Brain Stimulation for Obsessive-Compulsive Disorder

T2 - Optimal stimulation sites

AU - Meyer, Garance M

AU - Hollunder, Barbara

AU - Li, Ningfei

AU - Butenko, Konstantin

AU - Dembek, Till A

AU - Hart, Lauren

AU - Nombela, Cristina

AU - Mosley, Philip

AU - Akram, Harith

AU - Acevedo, Nicola

AU - Borron, Benjamin M

AU - Chou, Tina

AU - Castaño Montoya, Juan Pablo

AU - Strange, Bryan

AU - Barcia, Juan A

AU - Tyagi, Himanshu

AU - Castle, David J

AU - Smith, Andrew H

AU - Choi, Ki Sueng

AU - Kopell, Brian H

AU - Mayberg, Helen S

AU - Sheth, Sameer A

AU - Goodman, Wayne

AU - Leentjens, Albert F G

AU - Richardson, R Mark

AU - Rossell, Susan L

AU - Bosanac, Peter

AU - Cosgrove, G Rees

AU - Kuhn, Jens

AU - Visser-Vandewalle, Veerle

AU - Figee, Martijn

AU - Dougherty, Darin D

AU - Siddiqi, Shan H

AU - Zrinzo, Ludvic

AU - Joyce, Eileen

AU - Baldermann, Juan Carlos

AU - Fox, Michael D

AU - Neudorfer, Clemens

AU - Horn, Andreas

PY - 2024/7/15

Y1 - 2024/7/15

N2 - BACKGROUND: Deep brain stimulation (DBS) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Several stimulation targets have been used, mostly in and around the anterior limb of the internal capsule and ventral striatum (VC/VS). However, the precise target within this region remains a matter of debate. METHODS: Here, we retrospectively studied a multicenter cohort of 82 patients that underwent DBS of the VC/VS and mapped optimal stimulation sites in this region. RESULTS: DBS sweet-spot mapping performed on a discovery set of 58 patients revealed two optimal stimulation sites associated with improvements on the Yale-Brown Obsessive-Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract, and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from two additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements of depression. CONCLUSIONS: Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.

AB - BACKGROUND: Deep brain stimulation (DBS) is a promising treatment option for treatment-refractory obsessive-compulsive disorder (OCD). Several stimulation targets have been used, mostly in and around the anterior limb of the internal capsule and ventral striatum (VC/VS). However, the precise target within this region remains a matter of debate. METHODS: Here, we retrospectively studied a multicenter cohort of 82 patients that underwent DBS of the VC/VS and mapped optimal stimulation sites in this region. RESULTS: DBS sweet-spot mapping performed on a discovery set of 58 patients revealed two optimal stimulation sites associated with improvements on the Yale-Brown Obsessive-Compulsive Scale, one in the anterior limb of the internal capsule that overlapped with a previously identified OCD-DBS response tract, and one in the region of the inferior thalamic peduncle and bed nucleus of the stria terminalis. Critically, the nucleus accumbens proper and anterior commissure were associated with beneficial but suboptimal clinical improvements. Moreover, overlap with the resulting sweet- and sour-spots significantly estimated variance in outcomes in an independent cohort of 22 patients from two additional DBS centers. Finally, beyond obsessive-compulsive symptoms, stimulation of the anterior site was associated with optimal outcomes for both depression and anxiety, while the posterior site was only associated with improvements of depression. CONCLUSIONS: Our results suggest how to refine targeting of DBS in OCD and may be helpful in guiding DBS programming in existing patients.

KW - Anterior Limb of the Internal Capsule

KW - Bed Nucleus of the Stria Terminalis

KW - Deep Brain Stimulation

KW - Obsessive-Compulsive Disorder

KW - Sweet-spot

KW - Ventral Striatum

U2 - 10.1016/j.biopsych.2023.12.010

DO - 10.1016/j.biopsych.2023.12.010

M3 - Article

SN - 0006-3223

VL - 96

SP - 101

EP - 113

JO - Biological Psychiatry

JF - Biological Psychiatry

IS - 2

ER -

Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites

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Keywords

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