Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA, USA.
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA.
Neuron. 2024 Jan 3;112(1):73-83.e4. doi: 10.1016/j.neuron.2023.09.034. Epub 2023 Oct 20.
Treatment-resistant obsessive-compulsive disorder (OCD) occurs in approximately one-third of OCD patients. Obsessions may fluctuate over time but often occur or worsen in the presence of internal (emotional state and thoughts) and external (visual and tactile) triggering stimuli. Obsessive thoughts and related compulsive urges fluctuate (are episodic) and so may respond well to a time-locked brain stimulation strategy sensitive and responsive to these symptom fluctuations. Early evidence suggests that neural activity can be captured from ventral striatal regions implicated in OCD to guide such a closed-loop approach. Here, we report on a first-in-human application of responsive deep brain stimulation (rDBS) of the ventral striatum for a treatment-refractory OCD individual who also had comorbid epilepsy. Self-reported obsessive symptoms and provoked OCD-related distress correlated with ventral striatal electrophysiology. rDBS detected the time-domain area-based feature from invasive electroencephalography low-frequency oscillatory power fluctuations that triggered bursts of stimulation to ameliorate OCD symptoms in a closed-loop fashion. rDBS provided rapid, robust, and durable improvement in obsessions and compulsions. These results provide proof of concept for a personalized, physiologically guided DBS strategy for OCD.
治疗抵抗性强迫症（OCD）发生在大约三分之一的 OCD 患者中。强迫观念可能随时间波动，但通常在内部（情绪状态和思维）和外部（视觉和触觉）触发刺激存在时出现或恶化。强迫观念和相关的强迫冲动波动（是发作性的），因此可能对敏感且响应这些症状波动的定时脑刺激策略反应良好。早期证据表明，可以从与 OCD 相关的腹侧纹状体区域捕获神经活动，以指导这种闭环方法。在这里，我们报告了首例人类应用腹侧纹状体反应性深部脑刺激（rDBS）治疗难治性 OCD 个体的情况，该个体还患有共病性癫痫。自我报告的强迫症状和引发的 OCD 相关痛苦与腹侧纹状体的电生理学相关。rDBS 检测到侵入性脑电图低频振荡功率波动的基于时域区域的特征，这些波动触发刺激爆发，以闭环方式改善 OCD 症状。rDBS 迅速、稳健且持久地改善了强迫观念和强迫行为。这些结果为 OCD 的个性化、生理引导的 DBS 策略提供了概念验证。
