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，在美国有400-700万人受到影响。 患者在多个研究领域结构中受损。药物和行为疗法产生了 50%-70%的患者症状缓解不足。因此，强迫症仍然是全球领先的 残疾，相当于更明显的疾病，如精神分裂症。大约1/3的患者不能 由于他们的症状而工作，他们的照顾者报告了严重的、损害生活的压力。最近，这一领域 专注于脑深部刺激(DBS)。然而，接受DBS的患者中约有三分之一 没有得到任何有意义的好处。我们建议进行一项初步的基于影像的回顾性调查 针对严重强迫症(OCD)的深度脑刺激(DBS)。我们的目标是 提高应答率，同时测试可以指导治疗干预的成像生物标记物。我们的 医院是美国使用腹侧包膜/腹侧纹状体(VC/VS)DBS治疗容量最大的站点 顽固性强迫症的治疗。造成不完美反应的一个主要原因是星展银行被植入了标准银行 患者之间的协调，不考虑VC/VS解剖的差异。我们的调查将研究 可能针对DBS患者的腹囊/腹侧纹状体(VC/VS)的成像标志物 脑部电路。我们假设临床反应将与DBS电信号的程度有关 电场影响眼眶前额核-丘脑纤维和伏隔核灰质。如果我们在 在这项为期三年的回顾研究中确定生物标记物，未来的前瞻性临床试验将针对 DBS以患者特有的方式植入新发现的结构。

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.