Patient-specific, Effective, and Rational Functional Connectivity Targeting for DBS in OCD

针对 OCD 患者的 DBS 患者特定、有效且合理的功能连接目标

基本信息

批准号：
9381805
负责人：
DARIN D DOUGHERTY
金额：
$ 75.9万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-19 至 2020-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9381805
关键词：
Accounting Adverse effects Affect Aftercare Algorithms Anatomy Applications Grants Behavior Therapy Biological Markers Boston Caregivers Clinical Clinical Medicine Clinical Trials Complex Computer software Corpus striatum structure Country Data Data Set Databases Deep Brain Stimulation Diffusion Magnetic Resonance Imaging Disease Electric Stimulation Electrical Stimulation of the Brain Fiber Functional Magnetic Resonance Imaging Functional disorder Future Goals Grant Hospitals Image Impairment Implant Investigation Lateral Lead Life Light Link Magnetic Resonance Imaging Measures Modeling Nucleus Accumbens Obsessive compulsive behavior Obsessive-Compulsive Disorder Outcome Patients Pharmaceutical Preparations Play Postoperative Period Reporting Research Residual state Rest Retrospective Studies Retrospective cohort Role Schizophrenia Shapes Signal Transduction Site Stress Structure Symptoms Testing Thalamic structure Therapeutic Intervention Tissues Variant Ventral Striatum Work base brain circuitry capsule disability electric field experience fluorodeoxyglucose positron emission tomography glucose metabolism gray matter imaging biomarker imaging study improved improved outcome neural circuit neuroimaging predict clinical outcome prospective reduce symptoms response severe mental illness tractography white matter

项目摘要

ABSTRACT Obsessive-compulsive disorder (OCD) is a chronic mental illness affecting 4-7 million people in the US. Patients are impaired in multiple Research Domain constructs. Medication and behavioral therapies yield inadequate symptom relief in 50-70% of patients. As a result, OCD remains a leading worldwide cause of disability, equivalent to more visible disorders such as schizophrenia. Roughly 1/3 of patients are unable to work due to their symptoms and their caregivers report profound, life-impairing stress. More recently, the field has focused on deep brain stimulation (DBS). However, about a third of the patients who undergo DBS receive no meaningful benefit. We propose a primarily retrospective investigation of imaging-based targeting for Deep Brain Stimulation (DBS) for severe obsessive-compulsive disorder (OCD). We aim to increase response rates while testing imaging biomarkers that could guide therapeutic intervention. Our hospital is the highest-volume site in the US using DBS at the ventral capsule/ventral striatum (VC/VS) for the treatment of intractable OCD. A major contributor to imperfect response is that DBS is implanted at standard coordinates across patients, without accounting for variation in VC/VS anatomy. Our investigation will study imaging markers that may target ventral capsule/ventral striatum (VC/VS) for DBS to patient-specific brain circuitry. We hypothesize that clinical response will be related to the degree that the DBS electrical field influences orbitofronto-thalamic fibers and the nucleus accumbens grey matter. If we are successful in identifying a biomarker during this three-year retrospective study, a future prospective clinical trial will target DBS implants to the newly identified structures in a patient-specific fashion.

抽象的强迫症（OCD）是一种慢性精神疾病，影响了美国4-700万人。患者在多个研究领域构建体中受到损害。药物和行为疗法产生 50-70％的患者症状缓解不足。结果，强迫症仍然是全球主要的原因残疾，等同于更明显的疾病，例如精神分裂症。大约1/3的患者无法由于其症状和护理人员的症状而作出的工作报告了严重的，造成的压力。最近，该领域专注于深脑刺激（DBS）。但是，大约三分之一的患者接受了DBS 没有获得有意义的好处。我们提出了基于成像的主要回顾性研究针对严重强迫症（OCD）的深脑刺激（DBS）的靶向。我们的目标在测试可以指导治疗干预的成像生物标志物的同时提高响应率。我们的医院是美国使用腹胶囊/腹侧纹状体（VC/VS）的DB的最高体积部位治疗顽固性强迫症。导致不完美响应的主要因素是DBS以标准植入跨患者的坐标，而无需考虑VC/与解剖结构的变化。我们的调查将研究可能针对DBS腹胶囊/腹侧纹状体（VC/VS）的成像标记脑电路。我们假设临床反应将与DBS电气的程度有关田间影响轨道右丘脑纤维和伏伏核灰质。如果我们成功在这项为期三年的回顾性研究中确定生物标志物，未来的前瞻性临床试验将针对以特定于患者的方式植入新近识别的结构的DBS植入物。