Case Report of Dual-Site Neurostimulation and Chronic Recording of Cortico-Striatal Circuitry in a Patient With Treatment Refractory Obsessive Compulsive Disorder

作者：Sarah Olsen, Ishita Basu, Mustafa Taha Bilge, Anish Kanabar, Matthew Boggess, Alexander P. Rockhill, Aishwarya Gosai, Emily Hahn, Noam Peled, Michaela Ennis, Ilana Shiff, Katherine Fairbank-Haynes, Joshua D. Salvi, Cristina Cusin, Thilo Deckersbach, Ziv M. Williams, Justin T. Baker, Darin D. Dougherty, Alik S. Widge · 发表于：Frontiers in Human Neuroscience · 年份：2020 · DOI：10.3389/fnhum.2020.569973 · 被引用次数：43 · 研究领域：Obsessive-Compulsive Spectrum Disorders、Neurological disorders and treatments、Transcranial Magnetic Stimulation Studies

Psychiatric disorders are increasingly understood as dysfunctions of hyper- or hypoconnectivity in distributed brain circuits. A prototypical example is obsessive compulsive disorder (OCD), which has been repeatedly linked to hyper-connectivity of cortico-striatal-thalamo-cortical (CSTC) loops. Deep brain stimulation (DBS) and lesions of CSTC structures have shown promise for treating both OCD and related disorders involving over-expression of automatic/habitual behaviors. Physiologically, we propose that this CSTC hyper-connectivity may be reflected in high synchrony of neural firing between loop structures, which could be measured as coherent oscillations in the local field potential (LFP). Here we report the results from the pilot patient in an Early Feasibility study (https://clinicaltrials.gov/ct2/show/NCT03184454) in which we use the Medtronic Activa PC+ S device to simultaneously record and stimulate in the supplementary motor area (SMA) and ventral capsule/ventral striatum (VC/VS). We hypothesized that frequency-mismatched stimulation should disrupt coherence and reduce compulsive symptoms. The patient reported subjective improvement in OCD symptoms and showed evidence of improved cognitive control with the addition of cortical stimulation, but these changes were not reflected in primary rating scales specific to OCD and depression, or during blinded cortical stimulation. This subjective improvement was correlated with increased SMA and VC/VS coherence in the alpha, b...