101. A Unified Functional Network Target for Deep Brain Stimulation in Obsessive-Compulsive Disorder
- Author
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Bassam Al-Fatly, Harith Akram, Svenja Treu, Andrea A. Kühn, Ningfei Li, Stephan Chabardes, Bryan A. Strange, Veerle Visser-Vandewalle, Mircea Polosan, Astrid Kibleur, Jens H. Kuhn, Juan A. Barcia, Juan Carlos Baldermann, Andreas Horn, Ludvic Zrinzo, Barbara Hollunder, and Eileen M. Joyce
- Subjects
0301 basic medicine ,Obsessive-Compulsive Disorder ,Deep brain stimulation ,medicine.medical_treatment ,Deep Brain Stimulation ,Precuneus ,behavioral disciplines and activities ,03 medical and health sciences ,0302 clinical medicine ,Internal Capsule ,Subthalamic Nucleus ,Medicine ,Humans ,Biological Psychiatry ,Anterior cingulate cortex ,medicine.diagnostic_test ,business.industry ,Magnetic Resonance Imaging ,Subthalamic nucleus ,030104 developmental biology ,medicine.anatomical_structure ,Superior frontal gyrus ,Connectome ,business ,Functional magnetic resonance imaging ,Insula ,Neuroscience ,030217 neurology & neurosurgery - Abstract
Background Multiple deep brain stimulation (DBS) targets have been proposed for treating intractable obsessive-compulsive disorder (OCD). Here, we investigated whether stimulation effects of different target sites would be mediated by one common or several segregated functional brain networks. Methods First, seeding from active electrodes of 4 OCD patient cohorts (N = 50) receiving DBS to anterior limb of the internal capsule or subthalamic nucleus zones, optimal functional connectivity profiles for maximal Yale-Brown Obsessive Compulsive Scale improvements were calculated and cross-validated in leave-one-cohort-out and leave-one-patient-out designs. Second, we derived optimal target-specific connectivity patterns to determine brain regions mutually predictive of clinical outcome for both targets and others predictive for either target alone. Functional connectivity was defined using resting-state functional magnetic resonance imaging data acquired in 1000 healthy participants. Results While optimal functional connectivity profiles showed both commonalities and differences between target sites, robust cross-predictions of clinical improvements across OCD cohorts and targets suggested a shared network. Connectivity to the anterior cingulate cortex, insula, and precuneus, among other regions, was predictive regardless of stimulation target. Regions with maximal connectivity to these commonly predictive areas included the insula, superior frontal gyrus, anterior cingulate cortex, and anterior thalamus, as well as the original stereotactic targets. Conclusions Pinpointing the network modulated by DBS for OCD from different target sites identified a set of brain regions to which DBS electrodes associated with optimal outcomes were functionally connected—regardless of target choice. On these grounds, we establish potential brain areas that could prospectively inform additional or alternative neuromodulation targets for obsessive-compulsive disorder.
- Published
- 2021