Better deep brain stimulation therapy for OCD

Date:
December 9, 2021
Source:
NIH/National Institute of Neurological Disorders and Stroke
Summary:
Researchers captured more than 1,000 hours of brain recordings
from patients with OCD in the clinic and at home. These data are
a key first step towards designing improved deep brain stimulation
(DBS) treatments for neuropsychiatric disorders.



FULL STORY ==========================================================================
In a small study, researchers funded by the National Institutes of
Health captured more than 1,000 hours of brain recordings from patients
with OCD in the clinic and at home. These data are a key first step
towards designing improved deep brain stimulation (DBS) treatments for neuropsychiatric disorders. DBS has shown great promise for improving the
lives of people living with neurological disorders such as Parkinson's
disease, and is now gaining traction for treating psychiatric conditions
such as obsessive-compulsive disorder (OCD). The study is published
in Nature Medicine and funded through the NIH Brain Research Through
Advancing Innovative Neurotechnologies(R) (BRAIN) Initiative.


==========================================================================
"By combining at-home and in-clinic brain recordings, this study could
aid in the development of adaptive DBS treatments, which could be transformative for people living with OCD," said John J. Ngai, Ph.D.,
director of the NIH BRAIN Initiative. "This kind of far-reaching,
high-impact work is precisely what the BRAIN Initiative was established
to support." Researchers, led by David Borton, Ph.D., associate professor
of biomedical engineering at Brown University, Providence, Rhode Island,
and Wayne K.

Goodman, M.D., the D.C. and Irene Ellwood Chair in Psychiatry at
Baylor College of Medicine, Houston, collected brain recordings from
three patients who were already receiving DBS treatment for OCD. These recordings occurred in the clinic, during teletherapy sessions, and
during normal life activities at home.

These data will be used to correlate specific brain patterns with OCD
symptoms, with the goal being the identification of neural signatures
and related behaviors that predict the onset of symptoms and that can
be used to further refine DBS treatment. The at-home component to the recordings is a particularly important advancement, since that is the environment where patients are being exposed to the triggers that affect
their daily lives.

OCD and other neuropsychiatric disorders are challenging to treat with
DBS because the symptoms fluctuate over time. Unlike motor disorders,
such as Parkinson's disease that are commonly improved with DBS,
the symptoms of OCD come and go over time and can be triggered by the
person's environment.

"Currently, DBS therapy for OCD involves implanting the electrodes,
turning on the stimulation, and then fine-tuning that stimulation as best
as possible in the clinic," said Dr. Borton. "But because symptoms can
be triggered by many factors, the clinician is tuning the DBS system for
the patient at that moment in the clinic, but their needs could change significantly once they leave the clinic." Another enormous challenge
is the current lack of biomarkers -- distinct and measurable changes in
brain activity -- for OCD symptoms. In addition, changes in symptoms
in response to DBS for neuropsychiatric disorders can take weeks or
even months to occur once treatment begins. This means that clinicians programming the DBS system must rely on secondary behavioral changes
such as a positive affect response -- patients feel happier or more
talkative when stimulation is turned on.

"Changes in affect can tell us that we are stimulating the right area
of the brain, but not necessarily that the stimulation itself is ideally tuned," said Dr. Goodman.

The researchers in this study aimed to tackle these challenges by using
a technology similar to what had been previously used by BRAIN Initiative investigators in patients with Parkinson's disease.

In the current study, brain recordings were taken from the same electrodes responsible for delivering the DBS therapy and time-synched to EEG, other physiological recordings, and facial changes when recorded in the clinic;
to efforts to evoke symptom responses during teletherapy sessions; and
to self- reported symptoms during everyday life and during prescribed
tasks at home.

By combining these diverse data sets, the researchers were able to begin identifying candidate neurological signatures for OCD, such as brain
activity changes that occurred over time in correlation with clinical
scores for OCD symptoms. Going forward, the researchers plan to tweak
the stimulation in response to the candidate biomarkers to confirm
whether they can be used to impact the onset of symptoms. In addition, recordings from the cortical surface of patients, similar to what was
done in the study of Parkinson's disease, will be added to provide an additional layer of information.

This study builds on work by the OpenMind Consortium, a
cross-institutional partnership also funded through the NIH BRAIN
Initiative (U24NS113637). The study itself was funded by the NIH
BRAIN Initiative (UH3NS100549, UH3NS103549), NIH (MH121371, HD083092,
MH096951, MH116364, NS104953, MH101076, and OD025181), the Charles Stark
Draper Laboratory Fellowship, the McNair Foundation, the Texas Higher
Education Coordinating Board, and the Karen T. Romer Undergraduate
Teaching and Research Award at Brown University. The study was part of
an ongoing clinical trial to develop adaptive DBS for OCD (NCT042281134
and NCT03457675).

========================================================================== Story Source: Materials provided by NIH/National_Institute_of_Neurological_Disorders_and Stroke. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Nicole R. Provenza, Sameer A. Sheth, Evan M. Dastin-van Rijn,
Raissa K.

Mathura, Yaohan Ding, Gregory S. Vogt, Michelle Avendano-Ortega,
Nithya Ramakrishnan, Noam Peled, Luiz Fernando Fracassi Gelin, David
Xing, Laszlo A. Jeni, Itir Onal Ertugrul, Adriel Barrios-Anderson,
Evan Matteson, Andrew D. Wiese, Junqian Xu, Ashwin Viswanathan,
Matthew T.

Harrison, Kelly R. Bijanki, Eric A. Storch, Jeffrey F. Cohn,
Wayne K.

Goodman, David A. Borton. Long-term ecological assessment of
intracranial electrophysiology synchronized to behavioral markers
in obsessive- compulsive disorder. Nature Medicine, 2021; DOI:
10.1038/s41591-021- 01550-z ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/12/211209124220.htm

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