Patient-specific subnetwork connectivity predicts deep brain stimulation response in obsessive-compulsive disorder
Seilheimer, R.; Vardalakis, N.; Choi, W.; Qiu, L.; Campos, G.; Nho, Y.; Chen, H.; Shuvaev, S.; Scangos, K.; Chang, A.; McIntyre, C.; Oathes, D. J.; Ganguly, T.; Cristancho, M.; Brown, L.; Barbosa, D. A.; Pesaran, B.; Halpern, C.; Scangos, K.
Show abstract
Deep brain stimulation (DBS) can be an effective treatment for severe obsessive-compulsive disorder (OCD), but response is variable, and objective, reliable predictors of who will respond positively are absent. In three individuals with OCD, we implanted intracranial electrodes across the cortico-striato-limbic network before DBS. Prefrontal gamma activity, most prominently in the orbitofrontal cortex (OFC), distinguished high- from low-symptom OCD states reproducibly across days. Acute stimulation of the ventral capsule/ventral striatum relieved OCD symptoms and, in one patient, significantly shifted this OFC gamma signal. Effective connectivity from therapeutic stimulation sites to these prefrontal regions defined three patient-specific OCD subnetworks; the baseline strength of the nucleus accumbens/ventral pallidum-OFC subnetwork predicted acute and long-term DBS response. Imaging-based modeling of current propagation in stimulation-activated ventral capsule to the OFC tracked acute response, suggesting that this prediction could be approximated from imaging alone. These findings outline a predictive, subnetwork-level framework for personalized DBS in OCD.
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