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Toward Closed-Loop Intracranial Neurostimulation in Obsessive-Compulsive Disorder

Published:September 18, 2022DOI:https://doi.org/10.1016/j.biopsych.2022.07.003
      Studies in Parkinson’s disease have demonstrated suppression of symptoms using beta-band power intensity in the subthalamic nucleus as an adaptive control signal for deep brain stimulation (DBS) (
      • Gilron R.
      • Little S.
      • Perrone R.
      • Wilt R.
      • de Hemptinne C.
      • Yaroshinsky M.S.
      • et al.
      Long-term wireless streaming of neural recordings for circuit discovery and adaptive stimulation in individuals with Parkinson’s disease.
      ,
      • Feldmann L.K.
      • Neumann W.
      • Krause P.
      • Lofredi R.
      • Schneider G.
      • Kühn A.A.
      Subthalamic beta band suppression reflects effective neuromodulation in chronic recordings.
      ,
      • Plate A.
      • Hell F.
      • Mehrkens J.H.
      • Koeglsperger T.
      • Bovet A.
      • Stanslaski S.
      • Bötzel K.
      Peaks in the beta band of the human subthalamic nucleus: A case for low beta and high beta activity.
      ). While improvement in motor symptoms is readily evaluated, clinicians rely on subjective self-reporting to optimize DBS parameters and guide therapy in psychiatric diseases. Stimulation ideally would be tailored to electrophysiological biomarkers of the patient’s symptomatic state (
      • Vissani M.
      • Isaias I.U.
      • Mazzoni A.
      Deep brain stimulation: A review of the open neural engineering challenges.
      ). Several signals in the ventral capsule/ventral striatum (VC/VS) related to obsessive-compulsive disorder (OCD) symptom severity have been studied (
      • Olsen S.T.
      • Basu I.
      • Bilge M.T.
      • Kanabar A.
      • Boggess M.J.
      • Rockhill A.P.
      • et al.
      Case report of dual-site neurostimulation and chronic recording of cortico-striatal circuitry in a patient with treatment refractory obsessive compulsive disorder.
      ,
      • Miller K.J.
      • Prieto T.
      • Williams N.R.
      • Halpern C.H.
      Case Studies in Neuroscience: The electrophysiology of a human obsession in nucleus accumbens.
      ,
      • Xiong B.
      • Wen R.
      • Gao Y.
      • Wang W.
      Longitudinal changes of local field potential oscillations in nucleus accumbens and anterior limb of the internal capsule in obsessive-compulsive disorder [published online Jul 21].
      ), but no clear biomarker has emerged. Recently, a biomarker-driven closed-loop stimulation therapy was implemented in a patient with depression, stimulating VC/VS in response to amygdala gamma signals (
      • Scangos K.W.
      • Khambhati A.N.
      • Daly P.M.
      • Makhoul G.S.
      • Sugrue L.P.
      • Zamanian H.
      • et al.
      Closed-loop neuromodulation in an individual with treatment-resistant depression.
      ), illustrating the complexity and promise of these therapies for psychiatric disease.
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