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Identification of candidate neural biomarkers of OCD symptom intensity and response to Deep Brain Stimulation

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Abstract: Despite the success of deep brain stimulation (DBS) for treatment of refractory obsessive-compulsive disorder (OCD), there are currently no robust neural signatures for obsessive-compulsive (OC) symptoms or initial mood and energy improvements often associated with DBS . This may be due to limited opportunities available for conducting intracranial electrophysiological recordings in natural environments where fluctuations in symptoms take place. Recently available DBS platforms offer a way over this hurdle, allowing for streaming of intracranial neural activity both at home and in the clinic. Here, our goal was to identify neural correlates of both OC symptom intensity and acute changes in mood and energy. We conducted longitudinal intracranial recordings in nine participants with refractory OCD implanted with recording-capable DBS devices targeted to ventral capsule/ventral striatum (VC/VS). Four of the nine participants were implanted with additional sensing electrodes placed over the orbitofrontal cortex. We captured local field potentials at home during naturalistic exposures to OCD triggers, and in the clinic during variations in stimulation amplitude. All five participants who completed the study were clinical responders to DBS therapy. Using the intracranial data collected during OCD exposures, we computed correlations between spectral power and OCD symptom severity. We identified low delta-band power as a candidate neural biomarker of OC symptom intensity during symptom provocations in one participant (left VC/VS: R=-0.59, p=0.01; right VC/VS: R=-0.56, p=0.04). Electrophysiological analysis of acute response to stimulation revealed a peak in VC/VS alpha band activity that was suppressed with optimal DBS . In OFC , we found a native beta band peak that shifted to alpha band with optimal DBS . We consider these VC/VS and OFC spectral changes in alpha and beta bands as preliminary biomarkers of the initial changes in mood and energy commonly seen during VC/VS DBS . These signals have potential utility for classification of symptom intensity and increased mood and energy in adaptive DBS systems for OCD . Continued opportunities for long-term, naturalistic intracranial electrophysiological recordings will propel biomarker discovery for OCD and other psychiatric disorders.

Biography: Nicole Provenza is a postdoctoral fellow in Dr. Sameer Sheth’s laboratory at Baylor College of Medicine. Nicole completed her PhD in Biomedical Engineering in Dr. David Borton’s laboratory at Brown University in 2021, where she was awarded the Draper Fellowship for her graduate research. Her graduate work focused on developing adaptive deep brain stimulation for obsessive-compulsive disorder. As part of her graduate work, Nicole developed a research platform to collect intracranial local field potentials synchronized with disease-relevant behavior at home to aid in identification of neural biomarkers of obsessive-compulsive symptoms in natural environments.

This talk is part of the Department of Psychiatry & CPFT Thursday Lunchtime Seminar Series series.

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