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

Biol Psychiatry. 2023 Dec 21:S0006-3223(23)01785-7. doi: 10.1016/j.biopsych.2023.12.010. Online ahead of print.

Authors

Garance M Meyer¹, Barbara Hollunder², Ningfei Li³, Konstantin Butenko⁴, Till A Dembek⁵, Lauren Hart⁴, Cristina Nombela⁶, Philip Mosley⁷, Harith Akram⁸, Nicola Acevedo⁹, Benjamin M Borron¹⁰, Tina Chou¹⁰, Juan Pablo Castaño Montoya¹¹, Bryan Strange¹², Juan A Barcia¹¹, Himanshu Tyagi⁸, David J Castle¹³, Andrew H Smith¹⁴, Ki Sueng Choi¹⁵, Brian H Kopell¹⁶, Helen S Mayberg¹⁶, Sameer A Sheth¹⁷, Wayne Goodman¹⁷, Albert F G Leentjens¹⁸, R Mark Richardson¹⁹, Susan L Rossell⁹, Peter Bosanac²⁰, G Rees Cosgrove²¹, Jens Kuhn²², Veerle Visser-Vandewalle²³, Martijn Figee²⁴, Darin D Dougherty¹⁰, Shan H Siddiqi⁴, Ludvic Zrinzo⁸, Eileen Joyce⁸, Juan Carlos Baldermann²⁵, Michael D Fox⁴, Clemens Neudorfer²⁶, Andreas Horn²⁷

Affiliations

¹ Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: gmeyer3@bwh.harvard.edu.
² Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
³ Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.
⁴ Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
⁵ Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany.
⁶ Biological and Health Psychology, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain.
⁷ Clinical Brain Networks Group, QIMR Berghofer Medical Research Institute, Herston, Brisbane, Queensland, Australia; Neurosciences Queensland, St. Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia; Queensland Brain Institute, University of Queensland, St. Lucia, Brisbane, Queensland, Australia; Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Herston, Queensland, Australia.
⁸ Department of Clinical and Movement Neurosciences, University College London Queen Square Institute of Neurology, London, United Kingdom; National Hospital for Neurology and Neurosurgery, University College London Queen Square Institute of Neurology, London, United Kingdom.
⁹ Centre for Mental Health, Swinburne University, Melbourne, Victoria, Australia; St. Vincent's Hospital, Melbourne, Victoria, Australia.
¹⁰ Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
¹¹ Department of Neurosurgery, Hospital Clínico San Carlos, Instituto de Investigacion Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
¹² Laboratory for Clinical Neuroscience, Center for Biomedical Technology, Universidad Politécnica de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
¹³ University of Tasmania and Centre for Mental Health Service Innovation, Tasmania, Australia; State-wide Mental Health Service, Tasmania, Australia.
¹⁴ Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁵ Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁶ Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, New York.
¹⁷ Department of Electrical and Computer Engineering, Rice University, Houston, Texas; Department of Psychiatry and Behavioral Science, Baylor College of Medicine, Houston, Texas.
¹⁸ Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands.
¹⁹ Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
²⁰ St. Vincent's Hospital, Melbourne, Victoria, Australia; Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.
²¹ Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
²² Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, Johanniter Hospital Oberhausen, EVKLN, Oberhausen, Germany.
²³ Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
²⁴ Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
²⁵ Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
²⁶ Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
²⁷ Center for Brain Circuit Therapeutics, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

PMID: 38141909
DOI: 10.1016/j.biopsych.2023.12.010

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. However, the precise target within this region remains a matter of debate.

Methods: Here, we retrospectively studied a multicenter cohort of 82 patients with OCD who underwent DBS of the ventral capsule/ventral striatum and mapped optimal stimulation sites in this region.

Results: DBS sweet-spot mapping performed on a discovery set of 58 patients revealed 2 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 2 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 in 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.

Grants and funding

R01 MH123542/MH/NIMH NIH HHS/United States