Can Brain Scans Predict Who Will Benefit from Deep Brain Stimulation for OCD?

What you need to know

• Deep brain stimulation (DBS) can help some patients with severe, treatment-resistant obsessive-compulsive disorder (OCD), but does not work for everyone.
• This study aims to identify brain patterns that could predict which patients are most likely to benefit from DBS treatment.
• Researchers will use brain scans, cognitive tests, and recordings of brain activity before and after DBS to look for predictive biomarkers.
• If successful, this could help doctors select the best candidates for this invasive but potentially effective treatment.

Understanding OCD and Deep Brain Stimulation

Obsessive-compulsive disorder (OCD) is a common mental health condition that affects 2-3% of people worldwide. It involves intrusive, unwanted thoughts (obsessions) and repetitive behaviors or mental acts (compulsions) that a person feels driven to perform. While many people with OCD benefit from standard treatments like medication and cognitive-behavioral therapy, about 20-30% continue to have severe symptoms that significantly impact their quality of life.

For these treatment-resistant cases, deep brain stimulation (DBS) has emerged as a promising option. DBS involves surgically implanting thin wire electrodes into specific areas of the brain. These electrodes deliver carefully controlled electrical pulses that can help regulate abnormal brain activity. One target that has shown good results for OCD is an area called the subthalamic nucleus.

However, DBS is an invasive and expensive treatment that doesn’t work for everyone. Currently, doctors have limited ways to predict which patients are most likely to benefit. This study aims to address that problem by identifying “biomarkers” - measurable indicators in the brain that could forecast treatment response.

How the Study Will Work

The researchers will recruit 24 patients with severe, treatment-resistant OCD who are candidates for DBS. Before surgery, these patients will undergo:

1. Detailed clinical assessments of their OCD symptoms
2. Cognitive tests measuring things like impulse control and decision-making
3. Brain scans, including functional MRI to measure brain activity patterns
4. EEG recordings of electrical brain activity
5. During DBS surgery, recordings of activity directly from the subthalamic nucleus

After DBS implantation, patients will be followed for one year. The researchers will track changes in their symptoms and repeat some of the brain scans and cognitive tests.

For comparison, the study will also include 24 patients with similar severe OCD who will receive standard treatments instead of DBS, as well as 24 healthy volunteers without OCD.

What the Researchers Hope to Learn

The main goal is to see if any of the pre-treatment brain measures can predict how much a patient’s OCD symptoms improve with DBS. Some key things they’ll be looking at include:

• Patterns of connectivity between the subthalamic nucleus and other brain regions
• Activity in the subthalamic nucleus during tasks that require impulse control
• Low-frequency brain wave patterns, especially in frontal areas of the brain
• Performance on cognitive tests related to OCD symptoms

They also hope to gain insights into exactly how DBS changes brain function to reduce OCD symptoms. This could potentially lead to ways to make the treatment more effective.

Potential Impact

If successful, this study could provide doctors with a valuable tool for selecting patients most likely to benefit from DBS. This is important because, while DBS can be very effective for some, it’s also an invasive brain surgery with potential risks and side effects. Being able to better predict who will respond well could help ensure the treatment is used for those with the best chance of improvement.

Additionally, understanding more about the brain changes involved in successful DBS treatment may point to new targets for developing other OCD treatments in the future.

Conclusions

• This study aims to find brain-based biomarkers that could predict response to deep brain stimulation in severe OCD.
• If successful, it could help doctors select the best candidates for this invasive but potentially effective treatment.
• The research may also provide new insights into the brain mechanisms underlying OCD and its treatment.