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

Molecular Psychiatry, vol. 30, pp. 4274–4285

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.

Authors 14

1. Volker Arnd Coenen corresponding

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Center for Deep Brain Stimulation, Medical Center of the University of Freiburg, Freiburg im Breisgau, Germany. volker.coenen@uniklinik-freiburg.de

   Department of Stereotactic and Functional Neurosurgery, Medical Center of the University of Freiburg, Breisacher Straße 64, 79106, Freiburg, Germany. volker.coenen@uniklinik-freiburg.de

   Medical Faculty of the University of Freiburg, Breisacher Str. 153, 79110, Freiburg im Breisgau, Germany. volker.coenen@uniklinik-freiburg.de

2. Mircea Polosan

   Centre Hospitalier Universitaire de Grenoble

   Affiliation as printed

   Department of Psychiatry, Centre Hospitalier universitaire Grenoble Alpes, Grenoble Alpes, France

3. Thomas Eduard Schlaepfer

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Division of Interventional Biological Psychiatry/Department of Psychiatry and Psychotherapy, Medical Center of the University of Freiburg, Hauptstraße 5, 79104, Freiburg im Breisgau, Germany

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

4. Stéphan Chabardès

   Centre Hospitalier Universitaire de Grenoble

   Affiliation as printed

   Department of Neurosurgery, Centre Hospitalier universitaire, Grenoble Alpes, France

5. Dora M. Meyer

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Division of Interventional Biological Psychiatry/Department of Psychiatry and Psychotherapy, Medical Center of the University of Freiburg, Hauptstraße 5, 79104, Freiburg im Breisgau, Germany

6. Manuel Czornik

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Division of Interventional Biological Psychiatry/Department of Psychiatry and Psychotherapy, Medical Center of the University of Freiburg, Hauptstraße 5, 79104, Freiburg im Breisgau, Germany

7. Juan Carlos Baldermann

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Division of Interventional Biological Psychiatry/Department of Psychiatry and Psychotherapy, Medical Center of the University of Freiburg, Hauptstraße 5, 79104, Freiburg im Breisgau, Germany

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

8. Dominique Endres

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Psychiatry and Psychotherapy, Medical Center of the University of Freiburg, Hauptstraße 5, 79104, Freiburg im Breisgau, Germany

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

9. Horst Urbach

   University of Freiburg · University Medical Center Freiburg

   Affiliation as printed

   Department of Neuroradiology, 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

10. Peter Christoph Reinacher Aachen Fraunhofer Institute for Laser Technology (ILT)

    University of Freiburg · University Medical Center Freiburg · Fraunhofer Institute for Laser Technology

    Affiliation as printed

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

    Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany

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

11. Alexander Rau

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Killianstrasse 5a, 79106, Freiburg im Breisgau, Germany

    Department of Neuroradiology, 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

12. Máté Daniel Döbrössy

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

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

    Stereotaxy and Interventional Neurosciences (SIN), Department of Stereotactic and Functional Neurosurgery, Breisacher Straße 64, 79106, Freiburg im Breisgau, Germany

13. Bastian Sajonz

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    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

14. Marco Reisert

    University of Freiburg · University Medical Center Freiburg

    Affiliation as printed

    Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Killianstrasse 5a, 79106, Freiburg im Breisgau, Germany

    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