Connectomic Deep Brain Stimulation for Obsessive Compulsive Disorder

连接组深部脑刺激治疗强迫症

• 批准号: 10211224
• 负责人: Ki Sueng Choi
• 金额: $ 74.48万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10211224
• 关键词: Acute; Anatomy; Anterior; Atlases; Axon; Behavior Therapy; Behavioral; Brain; Brain Mapping; Brain Stem; Clinical; Complex; Data; Deep Brain Stimulation; Electrophysiology (science); Evoked Potentials; Fiber; Individual; Internal Capsule; Knowledge; Limb structure; Link; Location; Maps; Measures; Mediating; Methods; Obsessive-Compulsive Disorder; Operative Surgical Procedures; Outcome; Pathologic; Pathway interactions; Patients; Pharmaceutical Preparations; Physiologic pulse; Prevalence; Refractory; Research; Rewards; Specific qualifier value; Specificity; Structure; Task Performances; Techniques; Testing; Thalamic structure; Therapeutic; Time; To specify; Travel; Work; behavior change; behavior test; behavioral outcome; brain pathway; connectome; effective therapy; individual patient; magnetic resonance imaging/electroencephalography; neuropsychiatric disorder; neuropsychiatry; novel; response; success; tool; tractography; white matter

Project summary Treatment of severe obsessive-compulsive disorder (OCD) with deep brain stimulation (DBS) is evolving to provide precision modulation of pathological brain circuits. One promising DBS target for OCD is a large and complex white matter fiber bundle called the anterior limb of the internal capsule (ALIC). A clear challenge to effective dissemination of this treatment is the lack of specificity in targeting the necessary and sufficient ALIC pathways. To prepare DBS for broad dissemination, we must build the knowledge and tools to enhance the precision with which stimulation is applied to individual brains. The overarching hypothesis of the proposed research is that DBS-mediated responses (clinical, behavioral, and electrocortical) reflect activation of specific pathways traveling through the ALIC. In testing this hypothesis, our proposal will construct an atlas of circuit- response maps, which can be used to guide clinical programming decisions and enhance the precision of surgical targeting for ALIC DBS. Individuals receiving ALIC DBS to treat OCD (n=20) will undergo 7T magnetic resonance imaging and electroencephalography, as well as behavioral testing at multiple time points. Aim 1 will produce a connectome blueprint that characterizes white matter pathways implicated in effective treatment of OCD. Aim 2 provides a patient-level, electrophysiological read-out to indicate which pathways are stimulated at tractography-defined locations in the ALIC. Aim 3 constructs a behavioral-connectome blueprint by linking change in task performance to DBS at tractography-defined locations in the ALIC. Combined, this research constructs a connectomic atlas for OCD using the association of white matter structures, electrocortical response and behavioral outcomes to specify the ideal anatomical target for DBS.

项目概要 深部脑刺激（DBS）治疗严重强迫症（OCD）的方法是 不断发展以提供病理性脑回路的精确调制。星展银行的一个有希望的目标 对于强迫症来说，是一个大而复杂的白质纤维束，称为内部前肢 胶囊（ALIC）。有效传播这种治疗方法的一个明显挑战是缺乏 针对必要且充分的 ALIC 途径的特异性。为星展银行的广泛应用做好准备 传播，我们必须建立知识和工具来提高传播的准确性 刺激应用于个体大脑。拟议研究的总体假设 DBS 介导的反应（临床、行为和皮层电）反映了 通过 ALIC 的特定路径。在检验这个假设时，我们的建议将构建 电路反应图谱，可用于指导临床规划决策 提高 ALIC DBS 手术靶向的精度。接受 ALIC DBS 的个人 治疗强迫症（n = 20）将接受7T磁共振成像和脑电图检查，如 以及多个时间点的行为测试。目标 1 将产生一个连接组蓝图 描述了与强迫症有效治疗相关的白质通路。目标 2 提供了 患者水平的电生理读数表明哪些通路受到刺激 ALIC 中纤维束成像定义的位置。目标 3 构建行为连接组蓝图 通过将任务表现的变化与 ALIC 中纤维束成像定义位置的 DBS 联系起来。 结合起来，这项研究利用白人的关联构建了强迫症的连接组图谱 物质结构、皮层反应和行为结果来指定理想的 DBS 的解剖目标。