Case Report of Dual-Site Neurostimulation and Chronic Recording of Cortico-Striatal Circuitry in a Patient With Treatment Refractory Obsessive Compulsive Disorder

Sarah T. Olsen, Ishita Basu, Mustafa Taha Bilge, Anish Kanabar, Matthew J. Boggess, Alexander P. Rockhill, Aishwarya K. Gosai, Emily Hahn, Noam Peled, Michaela Ennis, Ilana Shiff, Katherine Fairbank-Haynes, Joshua D. Salvi, Cristina Cusin, Thilo Deckersbach, Ziv Williams, Justin T. Baker, Darin D. Dougherty, Alik S. Widge

Research output: Contribution to journalArticlepeer-review

Abstract

Psychiatric disorders are increasingly understood as dysfunctions of hyper- or hypoconnectivity in distributed brain circuits. A prototypical example is obsessive compulsive disorder (OCD), which has been repeatedly linked to hyper-connectivity of cortico-striatal-thalamo-cortical (CSTC) loops. Deep brain stimulation (DBS) and lesions of CSTC structures have shown promise for treating both OCD and related disorders involving over-expression of automatic/habitual behaviors. Physiologically, we propose that this CSTC hyper-connectivity may be reflected in high synchrony of neural firing between loop structures, which could be measured as coherent oscillations in the local field potential (LFP). Here we report the results from the pilot patient in an Early Feasibility study (https://clinicaltrials.gov/ct2/show/NCT03184454) in which we use the Medtronic Activa PC+ S device to simultaneously record and stimulate in the supplementary motor area (SMA) and ventral capsule/ventral striatum (VC/VS). We hypothesized that frequency-mismatched stimulation should disrupt coherence and reduce compulsive symptoms. The patient reported subjective improvement in OCD symptoms and showed evidence of improved cognitive control with the addition of cortical stimulation, but these changes were not reflected in primary rating scales specific to OCD and depression, or during blinded cortical stimulation. This subjective improvement was correlated with increased SMA and VC/VS coherence in the alpha, beta, and gamma bands, signals which persisted after correcting for stimulation artifacts. We discuss the implications of this research, and propose future directions for research in network modulation in OCD and more broadly across psychiatric disorders.

Original languageEnglish (US)
Article number569973
JournalFrontiers in Human Neuroscience
Volume14
DOIs
StatePublished - Oct 23 2020

Bibliographical note

Funding Information:
This study was supported by the NIH (UH3-NS100548-01), NIH (U01MH116925), the MnDRIVE Brain Conditions Program, and the University of Minnesota Medical Discovery Team on Addictions.

Publisher Copyright:
© Copyright © 2020 Olsen, Basu, Bilge, Kanabar, Boggess, Rockhill, Gosai, Hahn, Peled, Ennis, Shiff, Fairbank-Haynes, Salvi, Cusin, Deckersbach, Williams, Baker, Dougherty and Widge.

Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.

Keywords

  • cortico-striatal circuitry
  • local field potential
  • neural oscillations
  • neurostimulation
  • obsessive compulsive disorder
  • supplementary motor area
  • synchrony
  • ventral capsule/ventral striatum

PubMed: MeSH publication types

  • Journal Article

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