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Deconstructing a common pathway concept for Deep Brain Stimulation in the case of Obsessive-Compulsive Disorder.

作者信息

Coenen Volker A, Polosan Mircea, Schläpfer Thomas E, Chabardes Stephan, Meyer-Doll Dora M, Czornik Manuel, Sürücü Oskan, Baldermann Juan Carlos, Endres Dominique, Urbach Horst, Reinacher Peter C, Rau Alexander, Döbrössy Máté D, Sajonz Bastian E A, Reisert Marco

机构信息

Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany.

Medical Faculty of the University of Freiburg, Breisacher Str. 153, 79110, Freiburg im Breisgau, Germany.

出版信息

Mol Psychiatry. 2025 Apr 6. doi: 10.1038/s41380-025-03008-x.


DOI:10.1038/s41380-025-03008-x
PMID:40189699
Abstract

Deep Brain Stimulation (DBS) is a therapeutic option for treatment resistant (TR) obsessive-compulsive disorder (OCD). The OCD network comprises different sub-networks with homeostatic functions, altered under disease and modifiable with DBS. Connectomic analyses of DBS data sets have defined fiber selections explaining anti-OCD efficacy. This is a retrospective stimulation and outcome derived anatomical overlay analysis of 26 TR-OCD patients who received DBS at two academic centers. Grenoble, 14 anteromedial subthalamic nucleus (amSTN); Freiburg, 12 superolateral medial forebrain bundle (slMFB). Yale-Brown Obsessive Compulsive Scale improvement at 24 months served as outcome parameter. Structural proximity and outcomes were correlated using individual volumes of activated tissue for STN, slMFB, ORT (average OCD response tract) and further structures based on atlases or established connectomes. Connectomes (slMFB, ORT) were inspected for structural congruences. Normative connectomic data served to investigate cortical fiber penetration for the two target regions. Cortical sub-network conjugations were evaluated as peak levels. Our analyses revealed that ORT represents a fiber selection from the slMFB. DBS of amSTN and slMFB each address distinctive sub-networks while deep amSTN DBS can also address slMFB. Sub-network conjugations project amongst other regions onto the dorsomedial prefrontal cortex (dmPFC). The average ORT fiber selection is an integral part of the generic slMFB. Anti-OCD effects of amSTN DBS are not entirely explained by ORT overlay. The slMFB is dispersed and encompasses all OCD sub-networks and might qualify as a common DBS target when stimulated close to the ventral tegmental area. The dmPFC emerges as an interesting conjugation/hub between OCD sub-networks.

摘要

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本文引用的文献

[1]
Establishing connectivity through microdissections of midbrain stimulation-related neural circuits.

Brain. 2024-9-3

[2]
Modeling the volume of tissue activated in deep brain stimulation and its clinical influence: a review.

Front Hum Neurosci. 2024-4-10

[3]
Durable effects of deep brain ultrasonic neuromodulation on major depression: a case report.

J Med Case Rep. 2023-10-28

[4]
Anatomical characterisation of three different psychosurgical targets in the subthalamic area: from the basal ganglia to the limbic system.

Brain Struct Funct. 2023-11

[5]
Deconvoluting human Brodmann area 8 based on its unique structural and functional connectivity.

Front Neuroanat. 2023-6-22

[6]
Quantifying the Variability Associated with Postoperative Localization of Deep Brain Stimulation Electrodes.

Stereotact Funct Neurosurg. 2023

[7]
Tomographic tract tracing and data driven approaches to unravel complex 3D fiber anatomy of DBS relevant prefrontal projections to the diencephalic-mesencephalic junction in the marmoset.

Brain Stimul. 2023

[8]
Tractography-Based Modeling Explains Treatment Outcomes in Patients Undergoing Deep Brain Stimulation for Obsessive-Compulsive Disorder.

Biol Psychiatry. 2024-7-15

[9]
Where Position Matters-Deep-Learning-Driven Normalization and Coregistration of Computed Tomography in the Postoperative Analysis of Deep Brain Stimulation.

Neuromodulation. 2023-2

[10]
Tractography-based versus anatomical landmark-based targeting in vALIC deep brain stimulation for refractory obsessive-compulsive disorder.

Mol Psychiatry. 2022-12

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