Connectomic Deep Brain Stimulation for Obsessive Compulsive Disorder
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Obsessive Compulsive Disorder (OCD)
- Sponsor
- Icahn School of Medicine at Mount Sinai
- Enrollment
- 20
- Locations
- 1
- Primary Endpoint
- Change in Yale Brown Obsessive Compulsive Scale (Y-BOCS)
- Status
- Recruiting
- Last Updated
- 10 months ago
Overview
Brief Summary
Deep brain stimulation (DBS) is an effective treatment for people suffering from severe obsessive-compulsive disorder (OCD) whose symptoms have failed to improve after years and multiple methods of intervention. An effective DBS target for OCD is the anterior limb of the internal capsule (ALIC) brain region. On average 60% of all OCD patients have a clinically significant response to ALIC DBS. However, ALIC DBS may become even more effective with the ability to predict which specific ALIC connections in the brain need to be stimulated for each individual OCD patient. This study therefore investigates personalized stimulation to the ALIC that allows for precise modulation of brain circuits associated with individual OCD symptoms. The study aims to specify the ideal anatomical target for ALIC DBS for maximum therapeutic benefit in each patient.
Detailed Description
To improve DBS for severe OCD, the anatomical specificity with which stimulation is delivered must be enhanced. In this study, patients will receive personalized and circuit specific stimulation to five target ALIC pathways based on pre-surgery brain scan analysis where patient-specific blueprints are created and used to determine implant location. Stimulation to the ALIC is delivered by directional segmented electrodes which are designed to deliver precise activation of circuits of interest and minimize excess tissue activation that can cause side effects. In this study, ALIC DBS will target white matter pathways, each having different cortical projections that affect different behavioral outputs, instead of traditional targeting. Each of these chosen pathways have been shown to be involved in the effects of ALIC DBS for OCD, but the results vary between studies. The current study involves routine implantation of bilateral DBS leads into the ALIC brain region, which are connected to an internal pulse generator (IPG) device that is implanted under the skin near the collar bone and controls stimulation delivery. Before surgery, patients will receive a high definition 7T MRI brain scan to carefully plan the personalized lead implantation. Following surgery, patients will receive routine clinical visits for optimizing the DBS parameters and monitoring of clinical effects. As part of this study, patients will participate in EEG recordings at stimulation initiation and after 6 and 12 months. In addition, patients will complete behavioral paradigm testing bimonthly during stimulation of circuit-specific DBS contacts. The goal of this study is to create a blueprint map of the brain that characterizes pathways that are found in effective treatment of OCD. This will be done by determining which pathways are activated by stimulation in different locations in ALIC and linking these locations with changes in task performance. This will allow for specification of the ideal anatomical target for DBS for OCD for maximum therapeutic benefit.
Investigators
Martijn Figee
Associate Professor
Icahn School of Medicine at Mount Sinai
Eligibility Criteria
Inclusion Criteria
- Not provided
Exclusion Criteria
- Not provided
Outcomes
Primary Outcomes
Change in Yale Brown Obsessive Compulsive Scale (Y-BOCS)
Time Frame: Pre-surgical baseline, monthly up to 12 months postoperative
This scale measures change in OCD symptom severity. Full scale from from 0 - 40 with higher score indicating more severe symptoms.
Secondary Outcomes
- Reversal Task(Pre-surgical baseline, bimonthly up to 12 months postoperative)
- Change in Beck Depression Inventory (BDI)(Pre-surgical baseline, monthly up to 12 months postoperative)
- Tractography pathway activation models (Diffusion-weighted-imaging)(Baseline: Pre-surgery)
- Deep brain stimulation evoked potentials (EEG)(postoperative months 0, 6, 12)
- Change in Beck Anxiety Inventory (BAI)(Pre-surgical baseline, monthly up to 12 months postoperative)
- Investment Task(Pre-surgical baseline, bimonthly up to 12 months postoperative)
- Change in Young Mania Rating Scale (YMRS)(Pre-surgical baseline, monthly up to 12 months postoperative)
- Stop Signal Task(Pre-surgical baseline, bimonthly up to 12 months postoperative)
- Change in Barratt Impulsiveness Scale (BIS-11)(Pre-surgical baseline, monthly up to 12 months postoperative)
- Change in Columbia-Suicide Severity Rating Scale (C-SSRS)(Pre-surgical baseline, monthly up to 12 months postoperative)