Publication Date
10-1-2024
Journal
Nature Medicine
DOI
10.1038/s41591-024-03125-0
PMID
38997607
PMCID
PMC11485242
PubMedCentral® Posted Date
7-12-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Adult, Female, Humans, Male, Middle Aged, Deep Brain Stimulation, Obsessive-Compulsive Disorder, Periodicity, Treatment Outcome, Ventral Striatum, Predictive markers, Anxiety, Cognitive control, Neural decoding
Abstract
Recent advances in surgical neuromodulation have enabled chronic and continuous intracranial monitoring during everyday life. We used this opportunity to identify neural predictors of clinical state in 12 individuals with treatment-resistant obsessive-compulsive disorder (OCD) receiving deep brain stimulation (DBS) therapy ( NCT05915741 ). We developed our neurobehavioral models based on continuous neural recordings in the region of the ventral striatum in an initial cohort of five patients and tested and validated them in a held-out cohort of seven additional patients. Before DBS activation, in the most symptomatic state, theta/alpha (9 Hz) power evidenced a prominent circadian pattern and a high degree of predictability. In patients with persistent symptoms (non-responders), predictability of the neural data remained consistently high. On the other hand, in patients who improved symptomatically (responders), predictability of the neural data was significantly diminished. This neural feature accurately classified clinical status even in patients with limited duration recordings, indicating generalizability that could facilitate therapeutic decision-making.