Abstract
Deep brain stimulation (DBS) of the ventral internal capsule/ventral striatum (VCVS) is an emerging treatment for obsessive-compulsive disorder (OCD). Recently, multiple studies using normative connectomes have correlated DBS outcomes to stimulation of specific white matter tracts. Those studies did not test whether these correlations are clinically predictive, and did not apply cross-validation approaches that are necessary for biomarker development. Further, they did not account for the possibility of systematic differences between DBS patients and the non-diagnosed controls used in normative connectomes. To address these gaps, we performed patient-specific diffusion imaging in 8 patients who underwent VCVS DBS for OCD. We delineated tracts connecting thalamus and subthalamic nucleus (STN) to prefrontal cortex via VCVS. We then calculated which tracts were likely activated by individual patients’ DBS settings. We fit multiple statistical models to predict both OCD and depression outcomes from tract activation. We further attempted to predict hypomania, a VCVS DBS complication. We assessed all models’ performance on held-out test sets. With this best-practices approach, no model predicted OCD response, depression response, or hypomania above chance. Coefficient inspection partly supported prior reports, in that capture of tracts projecting to cingulate cortex was associated with both YBOCS and MADRS response. In contrast to prior reports, however, tracts connected to STN were not reliably correlated with response. Thus, patient-specific imaging and a guideline-adherent analysis were unable to identify a tractographic target with sufficient effect size to drive clinical decision-making or predict individual outcomes. These findings suggest caution in interpreting the results of normative connectome studies.
Original language | English (US) |
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Pages (from-to) | 965-972 |
Number of pages | 8 |
Journal | Neuropsychopharmacology |
Volume | 47 |
Issue number | 4 |
Early online date | Oct 7 2021 |
DOIs | |
State | Published - Oct 7 2021 |
Bibliographical note
Funding Information:This work was supported by NIH grants R03MH111320 (ASW, CCM, DDD), UH3NS100548 (ASW, DDD), R01MH111917 (ASW, DDD, NM, YR), U01MH076179 (BDG), P20GM130452 (NCM, BDG), K23MH100607 (NCM), K24MH116366 (NM), and P50MH106435 (NCM, BDG). ASW further acknowledges support from the MnDRIVE Brain Conditions and Minnesota Medical Discovery Team – Addictions initiatives. All opinions and conclusions herein are those of the authors. They do not represent the views or official policy of any public or private funding body.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to American College of Neuropsychopharmacology.