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Tractography-based versus anatomical landmark-based targeting in vALIC deep brain stimulation for refractory obsessive-compulsive disorder


Deep brain stimulation (DBS) of the ventral anterior limb of the internal capsule (vALIC) is effective for refractory obsessive-compulsive disorder (OCD). Retrospective evaluation showed that stimulation closer to the supero-lateral branch of the medial forebrain bundle (slMFB), within the vALIC, was associated with better response to DBS. The present study is the first to compare outcomes of DBS targeted at the vALIC using anatomical landmarks and DBS with connectomic tractography-based targeting of the slMFB. We included 20 OCD-patients with anatomical landmark-based DBS of the vALIC that were propensity score matched to 20 patients with tractography-based targeting of electrodes in the slMFB. After one year, we compared severity of OCD, anxiety and depression symptoms, response rates, time to response, number of parameter adjustments, average current, medication usage and stimulation-related adverse effects. There was no difference in Y-BOCS decrease between patients with anatomical landmark-based and tractography-based DBS. Nine (45%) patients with anatomical landmark-based DBS and 13 (65%) patients with tractography-based DBS were responders (BF10 = 1.24). The course of depression and anxiety symptoms, time to response, number of stimulation adjustments or medication usage did not differ between groups. Patients with tractography-based DBS experienced fewer stimulation-related adverse effects than patients with anatomical landmark-based DBS (38 vs 58 transient and 1 vs. 17 lasting adverse effects; BF10 = 14.968). OCD symptoms in patients with anatomical landmark-based DBS of the vALIC and tractography-based DBS of the slMFB decrease equally, but patients with tractography-based DBS experience less adverse effects.

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Fig. 1: Tractographic planning.
Fig. 2: Clinical symptom scores.


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The present study received no funding. PR Schuurman acts as independent advisor for Medtronic and Boston Scientific. RJT Mocking and IO Bergfeld are funded by unrestricted ABC Talent Grants. DD, PRS, GvW and IO Bergfeld have received funding from ZonMw (nr 636310016) and Boston Scientific (in kind) for a trial on deep brain stimulation for depression. GvW received research funding from Philips. The other authors have no disclosures to report.

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Conception and design: IG, RM, LL, IO, and DD. Data/literature acquisition: IG and IO. Data/literature analysis and interpretation: IG, IO, and RM. Statistical analysis: IG, IO, and RM. Drafting the manuscript: IG. Critical revision of the manuscript: All authors. Supervision: RM, IO, GvW, and DD.

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Correspondence to Ilse Graat.

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Graat, I., Mocking, R.J.T., Liebrand, L.C. et al. Tractography-based versus anatomical landmark-based targeting in vALIC deep brain stimulation for refractory obsessive-compulsive disorder. Mol Psychiatry 27, 5206–5212 (2022).

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