Patient-specific, Effective, and Rational Functional Connectivity Targeting for DBS in OCD

摘要 强迫症（OCD）是一种慢性精神疾病，在美国影响着400 - 700万人。 患者在多个研究领域结构中受损。药物治疗和行为疗法 50-70%的患者症状缓解不足。因此，强迫症仍然是世界范围内的主要原因， 残疾，相当于精神分裂症等更明显的疾病。大约1/3的患者无法 他们的工作和他们的照顾者报告说，深刻的，损害生活的压力。最近，该领域 脑深部电刺激（DBS）然而，大约三分之一接受DBS的患者 没有得到任何有意义的好处。我们提出了一个主要的回顾性调查， 深度脑刺激（DBS）治疗严重强迫症（OCD）。我们的目标是 提高响应率，同时测试可以指导治疗干预的成像生物标志物。我们 医院是美国在腹侧囊/腹侧纹状体（VC/VS）使用DBS进行 治疗顽固性强迫症不完美反应的一个主要原因是DBS是以标准植入的， 在不考虑VC/VS解剖结构变化的情况下协调患者。我们的调查将研究 可能靶向腹侧囊/腹侧纹状体（VC/VS）的成像标记物，用于DBS， 大脑回路我们假设临床反应与DBS电刺激的程度有关。 场影响眶额丘脑纤维和脑桥核灰质。如果我们成功地 在这项为期三年的回顾性研究中确定生物标志物，未来的前瞻性临床试验将针对 以患者特定的方式将DBS植入新识别的结构。

ABSTRACT Obsessive-compulsive disorder (OCD) is a chronic mental illness affecting 4-7 million people in the US. Patients are impaired in multiple Research Domain constructs. Medication and behavioral therapies yield inadequate symptom relief in 50-70% of patients. As a result, OCD remains a leading worldwide cause of disability, equivalent to more visible disorders such as schizophrenia. Roughly 1/3 of patients are unable to work due to their symptoms and their caregivers report profound, life-impairing stress. More recently, the field has focused on deep brain stimulation (DBS). However, about a third of the patients who undergo DBS receive no meaningful benefit. We propose a primarily retrospective investigation of imaging-based targeting for Deep Brain Stimulation (DBS) for severe obsessive-compulsive disorder (OCD). We aim to increase response rates while testing imaging biomarkers that could guide therapeutic intervention. Our hospital is the highest-volume site in the US using DBS at the ventral capsule/ventral striatum (VC/VS) for the treatment of intractable OCD. A major contributor to imperfect response is that DBS is implanted at standard coordinates across patients, without accounting for variation in VC/VS anatomy. Our investigation will study imaging markers that may target ventral capsule/ventral striatum (VC/VS) for DBS to patient-specific brain circuitry. We hypothesize that clinical response will be related to the degree that the DBS electrical field influences orbitofronto-thalamic fibers and the nucleus accumbens grey matter. If we are successful in identifying a biomarker during this three-year retrospective study, a future prospective clinical trial will target DBS implants to the newly identified structures in a patient-specific fashion.