Objectives

Obsessive–compulsive disorder (OCD) is a psychiatric disorder with alterations of cortico-striato-thalamo-cortical loops and impaired performance monitoring. Electrophysiological markers such as conflict-related medial frontal theta (MFT) and error-related negativity (ERN) may be altered by clinically effective deep brain stimulation (DBS) of the anterior limb of the internal capsule and nucleus accumbens (ALIC/NAc). We hypothesized that ALIC/NAc DBS modulates electrophysiological performance monitoring markers.

Materials and Methods

Fifteen patients (six male) with otherwise treatment-refractory OCD receiving ALIC/NAc DBS performed a flanker task with EEG recordings at three sessions: presurgery and at follow-up with DBS on and off. We examined MFT, ERN, and task performance. Furthermore, we investigated interrelations with clinical efficacy and then explored the influence of the location of individual stimulation volumes on EEG modulations.

Results

MFT and ERN were significantly attenuated by DBS with differences most pronounced between presurgery and DBS-on states. Also, we observed reaction time slowing for erroneous responses during DBS-off. Larger presurgery ERN amplitudes were associated with decreased clinical efficacy. Exploratory anatomical analyses suggested that stimulation volumes encompassing the NAc were associated with MFT modulation, whereas ALIC stimulation was associated with modulation of the ERN and clinical efficacy.

Conclusion

ALIC/NAc DBS diminished MFT and ERN, demonstrating modulation of the medial frontal performance monitoring system in OCD. Furthermore, our findings encourage further studies to explore the ERN as a potential predictor for clinical efficacy.

中文翻译：

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脑深部刺激可减少强迫症患者与冲突相关的 Theta 和错误相关的消极情绪

目标

强迫症（OCD）是一种精神疾病，伴有皮质-纹状体-丘脑-皮质环的改变和性能监测受损。内囊前肢和伏隔核 (ALIC/NAc) 的临床有效深部脑刺激 (DBS) 可能会改变电生理标志物，例如冲突相关的内侧额叶 (MFT) 和错误相关的负性 (ERN)。我们假设 ALIC/NAc DBS 调节电生理性能监测标志物。

材料和方法

15 名接受 ALIC/NAc DBS 治疗的难治性强迫症患者（6 名男性）在三个疗程中执行了一项侧翼任务，其中包括脑电图记录：术前和 DBS 开和关的随访。我们检查了 MFT、ERN 和任务性能。此外，我们研究了与临床疗效的相互关系，然后探讨了个体刺激体积的位置对脑电图调制的影响。

结果

MFT 和 ERN 被 DBS 显着减弱，术前和 DBS 开启状态之间的差异最为明显。此外，我们观察到 DBS 关闭期间错误响应的反应时间减慢。较大的术前ERN振幅与临床疗效降低有关。探索性解剖分析表明，包含 NAc 的刺激量与 MFT 调节相关，而 ALIC 刺激与 ERN 和临床疗效的调节相关。

结论

ALIC/NAc DBS 减少了 MFT 和 ERN，证明了 OCD 中内侧额叶性能监测系统的调制。此外，我们的研究结果鼓励进一步研究探索 ERN 作为临床疗效的潜在预测因子。