Provenza Nicole R, Rajesh Sameer V, Reyes Gabriel, Katlowitz Kalman A, Pugalenthi Lokesha S, Bechtold Raphael A, Diab Nabeel, Reddy Sandesh, Allam Anthony, Gandhi Ajay D, Kabotyanski Katya E, Mansourian Kasra A, Bentley Jonathan H, Altman Jordan R, Hinduja Saurabh, Giridharan Nisha, Banks Garrett P, Shofty Ben, Heilbronner Sarah R, Cohn Jeffrey F, Borton David A, Storch Eric A, Herron Jeffrey A, Hayden Benjamin Y, Phillips Mary L, Goodman Wayne K, Sheth Sameer A
Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA.
J Neurosci. 2025 Jan 31. doi: 10.1523/JNEUROSCI.1321-24.2025.
Deep brain stimulation (DBS) of the ventral capsule and ventral striatum (VC/VS) is an effective therapy for treatment resistant obsessive-compulsive disorder (trOCD). DBS initiation often produces acute improvements in mood and energy. These acute behavioral changes, which we refer to as "approach behaviors", include increased social engagement and talkativeness. We investigated the relationship between stimulation amplitude, spectral power in the ventrolateral prefrontal cortex (vlPFC), and speech rate in one male patient with trOCD implanted with bilateral VC/VS DBS leads and subdural electrodes adjacent to orbitofrontal cortex (OFC) and vlPFC. Several times over the first 17 weeks of therapy, we conducted experiments where we recorded data during epochs of high amplitude or zero/low amplitude stimulation. We found that both speech rate and vlPFC power in a high beta frequency band (31±1.5Hz, 1/f activity removed) increased during high amplitude as compared to low amplitude periods. Speech rate correlated with vlPFC high beta power. These effects were more consistent across time points in the left hemisphere than the right. At week 17, we performed an experiment where stimulation was held constant while the patient was asked to speak or remain silent. We showed that the presence or absence of speech was not sufficient to increase the vlPFC high beta power, suggesting stimulation is a key driver of the observed neurobehavioral phenomenon. Our results suggest vlPFC high beta power is a biomarker for approach behaviors associated with VC/VS DBS. In one patient receiving DBS of the ventral capsule and ventral striatum (VC/VS) for OCD, we leveraged a unique clinical opportunity to study the neurophysiological basis of approach behaviors using chronic intracranial recordings from prefrontal cortical regions. VC/VS DBS initiation often produces acute improvements in mood and energy associated with increased social engagement and talkativeness (approach behaviors). Our results suggest that vlPFC high beta activity (particularly in the left hemisphere) may index approach behaviors (quantified here by speech features). This neural signal is consistent with our previous non-invasive studies identifying predictors of mania in patients with bipolar disorder, and we hope to gather further evidence that it indexes a continuum from adaptive approach behavior to maladaptive manic symptoms.
腹侧囊和腹侧纹状体（VC/VS）的深部脑刺激（DBS）是治疗难治性强迫症（trOCD）的一种有效疗法。启动DBS通常会在情绪和精力方面产生急性改善。这些急性行为变化，我们称之为“趋近行为”，包括社交参与度增加和健谈。我们研究了刺激幅度、腹外侧前额叶皮层（vlPFC）的频谱功率与一名植入双侧VC/VS DBS电极以及眶额皮层（OFC）和vlPFC附近硬膜下电极的trOCD男性患者的语速之间的关系。在治疗的前17周内，我们多次进行实验，在高幅度或零/低幅度刺激期间记录数据。我们发现，与低幅度期相比，高幅度刺激期间语速和高β频段（31±1.5Hz，去除1/f活动）的vlPFC功率均增加。语速与vlPFC高β功率相关。这些效应在左半球的时间点上比右半球更一致。在第17周，我们进行了一项实验，在患者被要求说话或保持沉默时保持刺激恒定。我们发现，说话与否不足以增加vlPFC高β功率，这表明刺激是观察到的神经行为现象的关键驱动因素。我们的结果表明，vlPFC高β功率是与VC/VS DBS相关的趋近行为的生物标志物。在一名接受腹侧囊和腹侧纹状体（VC/VS）DBS治疗强迫症的患者中，我们利用了一个独特的临床机会，通过前额叶皮层区域的慢性颅内记录来研究趋近行为的神经生理基础。启动VC/VS DBS通常会在情绪和精力方面产生急性改善，这与社交参与度增加和健谈（趋近行为）有关。我们的结果表明，vlPFC高β活动（特别是在左半球）可能指示趋近行为（在此通过语音特征量化）。这种神经信号与我们之前在双相情感障碍患者中识别躁狂预测因子的非侵入性研究一致，我们希望收集更多证据表明它指示了从适应性趋近行为到适应不良躁狂症状的连续体。
