Our Research
DBS in Obsessive - Compulsive Disorder
Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a major cause of global disability. OCD is characterized by obsessions (i.e., unwanted intrusive thoughts) and compulsions (i.e., repetitive ritualistic behaviors), and exemplifies a pathologically avoidant phenotype where greater degrees of avoidance are associated with greater symptom severity and treatment resistance. In the 20-40% of OCD patients that are treatment refractory, deep brain stimulation (DBS) of the ventral capsule and ventral striatum (VC/VS) is an effective therapy that achieves significant benefit in 66% of patients.
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While VC/VS DBS does not acutely relieve OCD symptoms, DBS often produces a “pro-approach” response including an increase in talkativeness, a desire to engage in activities, extroversion, and affiliative behavior. Our hypothesis is that VC/VS DBS achieves eventual benefit in OCD by providing the “boost” in pro-approach behavior that allows individuals to overcome their pathological fear-based avoidance. Thus, we focus on the approach-avoidance axis as one of the critical neurobehavioral axes underlying the pathophysiology of OCD. Our overall goal is to develop a mechanistic understanding of DBS for OCD by rigorously investigating the relationship between clinical symptoms, behaviors (i.e., approachful vs. avoidant), and neurophysiology.
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In OCD patients with recording-capable DBS devices, we are collecting a broad array of neurobehavioral data in the clinic and the home. These data will allow us to use intracranial recordings from the ventral striatum to inform and validate the approach-avoidance framework and investigate the degree of explanatory power this framework has for OCD. By understanding the therapeutic mechanism driving OCD symptom improvement after VC/VS DBS, we will pave the way for rigorous, data-driven neuromodulatory strategies to regulate behavior and ameliorate symptoms in other disorders characterized by dysregulated approach-avoidance behavior.
Team leads: Tommy Liu, Zain Naqvi, Holden Bentley, Kasra Mansourian
Collaborators: Sameer Sheth, Wayne Goodman, Eric Storch, Jeffrey Herron, Ankit Patel, Benjamin Hayden
Illustration depicting prototypical clinical/behavioral states associated with OCD and its treatment with DBS. From left to right: Avoidant rituals of the severely symptomatic state, adaptive behaviors of clinical response, excessively approachful behaviors of over-stimulation, balanced sleep/wake patterns characteristic of clinical response. Illustration by Helen Tang. Adapted from Provenza et al., Nature Medicine 2024.