scholarly journals Patient-specific modeling of the volume of tissue activated (VTA) is associated with clinical outcome of DBS in patients with an obsessive-compulsive disorder

2021 ◽  
Author(s):  
Fuchang Jiang ◽  
Behzad Elahi ◽  
Mohit Saxena ◽  
Ilknur Telkes ◽  
Marisa DiMarzio ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Obsessive Compulsive Disorder ◽  
Patient Specific ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Patient Specific Modeling ◽  
Specific Modeling

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

2014 ◽  
Vol 121 (1) ◽  
pp. 123-130 ◽  
Author(s):  
Andre F. Gentil ◽  
Antonio C. Lopes ◽  
Darin D. Dougherty ◽  
Christian Rück ◽  
David Mataix-Cols ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Obsessive Compulsive Disorder ◽  
Limbic System ◽  
Sao Paulo ◽  
Response To Treatment ◽  
São Paulo ◽  
Obsessive Compulsive ◽  
Symptom Dimensions ◽  
Compulsive Disorder ◽  
Treatment Refractory

Object Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%–41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

‘Impulsive compulsivity’ in obsessive-compulsive disorder: A phenotypic marker of patients with poor clinical outcome

2012 ◽  
Vol 46 (9) ◽  
pp. 1146-1152 ◽  
Author(s):  
Himani Kashyap ◽  
Leonardo F. Fontenelle ◽  
Euripedes C. Miguel ◽  
Ygor A. Ferrão ◽  
Albina R. Torres ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Obsessive Compulsive Disorder ◽  
Poor Clinical Outcome ◽  
Obsessive Compulsive ◽  
Phenotypic Marker ◽  
Compulsive Disorder

scholarly journals A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder

Neurosurgery ◽  
2020 ◽  
Author(s):  
Nataly Raviv ◽  
Michael D Staudt ◽  
Andrew K Rock ◽  
Jacquelyn MacDonell ◽  
Julia Slyer ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Patient Specific ◽  
Obsessive Compulsive ◽  
Quality Of Evidence ◽  
Compulsive Disorder ◽  
Pubmed Database ◽  
Deep Brain

Abstract BACKGROUND Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated. OBJECTIVE To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature. METHODS A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms “DBS” and “OCD.” Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. RESULTS Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates. CONCLUSION The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.

Clinical outcome in patients with bipolar I disorder, obsessive compulsive disorder or both

2006 ◽  
Vol 21 (3) ◽  
pp. 189-193 ◽  
Author(s):  
Franca Centorrino ◽  
John Hennen ◽  
Gopinath Mallya ◽  
Samy Egli ◽  
Tim Clark ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Bipolar I Disorder ◽  
Compulsive Disorder

scholarly journals Patient-Specific Connectomic Models Correlate With, But Do Not Predict, Outcomes in Deep Brain Stimulation for Obsessive-Compulsive Disorder

2021 ◽  
Author(s):  
Alik S Widge ◽  
Fan Zhang ◽  
Aishwarya Gosai ◽  
George Papadimitrou ◽  
Peter Wilson-Braun ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Clinical Decision Making ◽  
Diffusion Imaging ◽  
Internal Capsule ◽  
Patient Specific ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Deep Brain

Background: 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. Methods: 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. Results: 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. Conclusions: 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.

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