Connectivity Profile Predictive of Effective Deep Brain Stimulation in Obsessive-Compulsive Disorder
Connectivity Profile Predictive of Effective Deep Brain Stimulation in Obsessive-Compulsive Disorder
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DOI：
10.1016/j.biopsych.2018.12.019
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发表时间：
2019-05-01
影响因子：
10.6
通讯作者：
Kuhn, Jens
中科院分区：
文献类型：
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作者：
Baldermann, Juan Carlos;Melzer, Corina;Kuhn, Jens
背景：脑深部电刺激治疗强迫症是一种快速发展的治疗难治性患者的治疗策略。确切的目标和对分布式大脑网络的影响仍然是一个有争议的问题。在这里，我们研究了哪些区域连接到刺激部位有助于临床改善效果，以及连接是否能够预测outcome.METHODS：我们分析了22例（13名女性）治疗难治性强迫症进行脑深部电刺激针对前肢的内囊/脑桥核。我们分别计算了10例患者的患者特异性连接数据和12例使用规范连接的额外患者的刺激依赖性最佳连接。随后，最佳连接性模型被用于预测整个组的样本外交叉验证和留一交叉验证的结果。结果：所得模型成功地交叉预测了相应其他样本的临床结果，并且整个组的留一交叉验证进一步证明了我们研究结果的稳健性（r = .630，p < .001）。具体而言，刺激部位与内侧和外侧前额叶皮质之间的连通程度显著预测临床改善。最后，我们划定了一个额丘脑通路，是至关重要的调制有益outcome.CONCLUSIONS：特定的连接配置文件，包括额丘脑流线，可以预测临床结果的脑深部电刺激强迫症。经过进一步验证，我们的研究结果可用于指导脑深部电刺激靶向和编程，并为强迫症的非侵入性神经调节靶点提供信息。
BACKGROUND: Deep brain stimulation for obsessive-compulsive disorder is a rapidly developing treatment strategy for treatment-refractory patients. Both the exact target and impact on distributed brain networks remain a matter of debate. Here, we investigated which regions connected to stimulation sites contribute to clinical improvement effects and whether connectivity is able to predict outcomes.METHODS: We analyzed 22 patients (13 female) with treatment-refractory obsessive-compulsive disorder undergoing deep brain stimulation targeting the anterior limb of the internal capsule/nucleus accumbens. We calculated stimulation-dependent optimal connectivity separately for patient-specific connectivity data of 10 patients and for 12 additional patients using normative connectivity. Models of optimal connectivity were subsequently used to predict outcome in both an out-of-sample cross-validation and a leave-one-out cross-validation across the whole group.RESULTS: The resulting models successfully cross-predicted clinical outcomes of the respective other sample, and a leave-one-out cross-validation across the whole group further demonstrated robustness of our findings (r = .630, p < .001). Specifically, the degree of connectivity between stimulation sites and medial and lateral prefrontal cortices significantly predicted clinical improvement. Finally, we delineated a frontothalamic pathway that is crucial to be modulated for beneficial outcome.CONCLUSIONS: Specific connectivity profiles, encompassing frontothalannic streamlines, can predict clinical outcome of deep brain stimulation for obsessive-compulsive disorder. After further validation, our findings may be used to guide both deep brain stimulation targeting and programming and to inform noninvasive neuromodulation targets for obsessive-compulsive disorder.