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

• DOI: 10.3389/fnhum.2023.1339340
• Publication Date: 2024-02-07T04:28:37Z
• Authors: Genevieve Basich-...; Natalya Slepneva; Adam C. Frank; Tenzin Norbu; Melanie A. Morrison; Leo P. Sugrue; Paul S. Larson; Philip A. Starr; A. Moses Lee
• Keywords: Depression; Neuromodulation; Lead (geology)

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