Tractography-based DBS lead repositioning improves outcome in refractory OCD and depression

Genevieve Basich-Pease; Natalya Slepneva; Adam C Frank; Tenzin Norbu; Melanie A Morrison; Leo P Sugrue; Paul S Larson; Philip A Starr; A Moses Lee

doi:10.3389/fnhum.2023.1339340

Tractography-based DBS lead repositioning improves outcome in refractory OCD and depression

Front Hum Neurosci. 2024 Feb 7:17:1339340. doi: 10.3389/fnhum.2023.1339340. eCollection 2023.

Authors

Genevieve Basich-Pease^{1

2}, Natalya Slepneva^{1

2}, Adam C Frank^{1

2

3}, Tenzin Norbu^{1

2}, Melanie A Morrison^{1

4}, Leo P Sugrue^{1

4}, Paul S Larson^{5

6}, Philip A Starr⁵, A Moses Lee^{1

2}

Affiliations

¹ Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.
² Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States.
³ Department of Psychiatry and Behavioral Sciences, Keck School of Medicine of USC, Los Angeles, CA, United States.
⁴ Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States.
⁵ Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
⁶ Department of Neurological Surgery, University of Arizona, Tucson, AZ, United States.

Abstract

Deep brain stimulation (DBS) of the anterior limb of the internal capsule (ALIC) has been used to treat refractory obsessive-compulsive disorder (OCD) and depression, but outcomes are variable, with some patients not responding to this form of invasive neuromodulation. A lack of benefit in some patients may be due to suboptimal positioning of DBS leads. Recently, studies have suggested that specific white matter tracts within the ALIC are associated with improved outcomes. Here, we present the case of a patient who initially had a modest improvement in OCD and depressive symptoms after receiving DBS within the ALIC. Subsequently, he underwent unilateral DBS lead repositioning informed by tractography targeting the ventrolateral and medial prefrontal cortex's connection with the mediodorsal thalamus. In this patient, we also conducted post-implant and post-repositioning diffusion imaging and found that we could successfully perform tractography even with DBS leads in place. Following lead repositioning into tracts predictive of benefit, the patient reached responder criteria for his OCD, and his depression was remitted. This case illustrates that tractography can potentially be used in the evaluation and planning of lead repositioning to achieve therapeutic outcomes.

Keywords: OCD; anterior limb of the internal capsule; deep brain stimulation; diffusion imaging; fMRI; tractography.

Publication types

Case Reports

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was supported by the National Institute of Mental Health (Grant nos. K23MH125018 and R21MH130914), the UCSF Team Science Research Allocation Program Grant, and the Foundation for OCD Research (Grant no. P0548058).