Toward a unified connectomic target for deep brain stimulation in obsessive-compulsive disorder

Multiple surgical targets have been proposed for treating obsessive-compulsive disorder (OCD) with Deep brain stimulation (DBS). However, different targets may lie along the same fiber bundle, which could be responsible for clinical improvement. Here we analyzed data from two cohorts of OCD patients that underwent DBS to either the anterior limb of the internal capsule (ALIC) or the subthalamic nucleus (STN). Fiber tracts that were predominantly connected to electrodes in top or poor DBS responders - based on improvement on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) - were isolated and each assigned a predictive value. Strikingly, the same fiber bundle that was positively discriminative of treatment response emerged in both cohorts, independently from each other. Using this tract, it was feasible to cross-predict clinical improvement across DBS targets, cohorts and centers. Our results suggest that obsessive-compulsive symptoms could indeed be modulated by stimulation of this specific bundle and demonstrate that connectomics-derived improvement models informed by patients operated in one target may predict outcome in patients operated in an alternative target.