Recording Local Field Potentials During Bilateral DBS of the ALIC/VS-VC During Treatment of Obsessive Compulsive Disorder
Yi-Han Lin1, Vicente Martinez2, Andrew Ko3, Michael Schrift4
1University of Washington, Neurology, 2Rehabilitation Medicine, 3Neurosurgery, 4Psychiatry, University of Washington
Background:
Obsessive–compulsive disorder (OCD) is a debilitating psychiatric illness characterized by time-consuming obsessions and/or compulsions that produce functional impairment. Neuroimaging data demonstrates a connection between OCD symptoms and aberrant activity within the cortico-striato-thalamo-cortical (CSTC) network. The anterior limb of the internal capsule/ventral capsule-ventral striatum (ALIC/VS-VC) represents an essential target for psychiatric neurosurgery due to its significance as a white matter convergence point connecting cortical networks to hippocampal, amygdaloid, thalamic, and brainstem structures. Evolving Medtronic BrainSense technology permits the continuous capture of local field potentials (LFPs) during the simultaneous delivery of DBS. Here we report a case study describing concurrent changes in OCD severity and LFPs of ALIC/VS-VC stimulation.
Design/Methods:
The subject is a 25-year-old male with a complex history of OCD and concurrent diagnoses of Tourette syndrome, anxiety, and depression. The patient underwent the bilateral implantation of Medtronic DBS leads in the ALIC/VS-VC paired with a Percept PC with BrainSense technology. LFP recording are performed during clinic visits as well as between appointments. During programming sessions, we attempted to evoke symptoms using an OCD provocation paradigm that presented photographic stimuli associated with the patient’s obsessions.
Results:
The patient’s YBOCS score improved by 22% 7 months following DBS activation. Baseline LFP recordings showed a consistent signal in the alpha range (at ~9Hz and ~12 Hz). Notably, when stimulation was adjusted to localize the alpha signal, this was associated with subsequent clinical improvement. Phasic changes in LFPs were not observed during OCD provocation, however, slight increases in alpha activity were observed after testing.
Conclusions:
Lateralized changes in alpha activity were observed during DBS activation and subsequent symptom attenuation. This case corroborates existing evidence implicating aberrant alpha activity in OCD and adds to the literature of potential biomarkers that can be used to guide parameter selection and track symptom responses in future OCD patients receiving DBS.