Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain; Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
Service of Neurosurgery, Hospital Clinico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain.
Brain Stimul. 2019 May-Jun;12(3):724-734. doi: 10.1016/j.brs.2018.12.226. Epub 2018 Dec 20.
Psychiatric conditions currently treated with deep brain stimulation (DBS), such as obsessive-compulsive disorder (OCD), are heterogeneous diseases with different symptomatic dimensions, indicating that fixed neuroanatomical DBS targets for all OCD cases may not be efficacious.
OBJECTIVE/HYPOTHESIS: We tested whether the optimal DBS target for OCD is fixed for all patients or whether it is individualized and related to each patient's symptomatic content. Further, we explored if the optimal target can be predicted by combining functional neuroimaging and structural connectivity.
In a prospective, randomized, double-blinded study in 7 OCD patients, symptomatic content was characterized pre-operatively by clinical interview and OCD symptom-provocation during functional MRI. DBS electrode implantation followed a trajectory placing 4 contacts along a striatal axis (nucleus accumbens to caudate). Patients underwent three-month stimulation periods for each contact (and sham), followed by clinical evaluation. Probabilistic tractography, applied to diffusion-weighted images acquired pre-operatively, was used to study the overlap between projections from the prefrontal areas activated during symptom provocation and the volume of activated tissue of each electrode contact.
Six patients were classified responders, with median symptomatic reduction of 50% achieved from each patient's best contact. This was located at the caudate in 4 cases and at the accumbens in 2. Critically, the anatomical locus of the best contact (accumbens or caudate) was related to an index derived by combining functional MRI responses to prevailing symptom provocation and prefronto-cortico-striatal projections defined by probabilistic tractography.
Our results therefore represent a step towards personalized, content-specific DBS targets for OCD.
目前使用深部脑刺激（DBS）治疗的精神疾病，如强迫症（OCD），是具有不同症状维度的异质疾病，这表明针对所有 OCD 病例的固定神经解剖 DBS 靶点可能并非有效。
目的/假设：我们测试 OCD 的最佳 DBS 靶点是否对所有患者都是固定的，或者它是否是个体化的，与每个患者的症状内容有关。此外，我们探讨了是否可以通过结合功能神经影像学和结构连接来预测最佳靶点。
在 7 例 OCD 患者的前瞻性、随机、双盲研究中，通过临床访谈和功能磁共振成像期间的 OCD 症状诱发，在术前对症状内容进行特征描述。DBS 电极植入遵循沿着纹状体轴（从伏隔核到尾状核）放置 4 个触点的轨迹。每位患者接受每个触点（和假刺激）三个月的刺激期，然后进行临床评估。在术前获得的弥散加权图像上应用概率追踪技术，研究在症状诱发期间激活的前额区域与每个电极触点的激活组织体积之间的投射重叠。
6 例患者被归类为反应者，每位患者的最佳触点均可使症状减轻中位数为 50%。其中 4 例位于尾状核，2 例位于伏隔核。关键的是，最佳触点（伏隔核或尾状核）的解剖位置与通过组合功能磁共振成像对主要症状诱发的反应以及概率追踪术定义的前额皮质-纹状体投射得出的指数有关。
因此，我们的结果代表了朝着 OCD 的个性化、特定内容的 DBS 靶点迈出的一步。
