Observational studyTranslational psychiatry2026
Patient-specific structural connectomic differences of deep brain stimulation targets in treatment-resistant obsessive-compulsive disorder patients.
Observational study in Translational psychiatry, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Deep brain stimulation (DBS) is an established therapy for treatment-resistant obsessive-compulsive disorder (trOCD), yet clinical outcomes vary. This is partly due to differential cortico-striato-thalamo-cortical networks (CSTC) engagement across stimulation in relevant anatomical regions. This study compared the structural and functional connectivity profiles of three relevant anatomical-regions that have also served as target for DBS in different centers for trOCD: the nucleus accumbens/anterior-limb of the internal-capsule (NAc/ALIC), the medial forebrain bundle (MFB), and the anteromedial subthalamic nucleus (amSTN). We analysed in a retrospective, observational, single-center cohort the structural connectivity on patient-specific space, using structural and diffusion MRI data from 22 trOCD patients treated with NAc/ALIC DBS at the University Hospital Cologne. For this end, Whole-brain probabilistic-tractography using single-shell-three-tissue constrained-spherical-deconvolution was applied to reconstruct patient-specific structural connectivity matrices. From whole-brain tractograms, target-specific streamline subsets were selected using ROI-based inclusion criteria using 2 mm radius spheric stereotactic ROIs representing clinically relevant trOCD-DBS target regions. Afterwards, Structural connectivity matrices were extracted using Spherical-deconvolution informed filtering of tractograms (SIFT) streamline count, fractional anisotropy (FA), and mean diffusivity (MD) across 13 cortico-subcortical regions implicated in OCD pathophysiology. Thereafter, we characterized each target's connectivity to key OCD functional networks derived from meta-analytic functional connectivity maps. NAc/ALIC demonstrated stronger structural fronto-limbic connectivity: medial-orbitofrontal cortex, anterior-cingulate, insula, and accumbens (p < 0.0001), associated with the affect (AN), salience (SN), default-mode (DMN), and reward-motivation (RMN) networks anatomical hubs. The MFB predominantly connected with reward-related regions: pallidum and rostral-middle-frontal cortex (p < 0.0001). The amSTN showed to be mainly connected to SN and the cognitive/motor control network (CMCN): precentral and paracentral gyri (p < 0.0001). These exploratory findings suggest that clinically relevant trOCD-DBS targets may engage distinct but partially overlapping tractography derived structural networks and meta-analytic functional networks. The observed connectivity profiles may help generate hypotheses about symptom-specific networks for future DBS planning. Overall, these results support the proof-of-concept value of patient-specific probabilistic tractography in trOCD. However, prospective validation in independent, multicentric trials remains necessary before clinical translation.
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