Neurosurgical interventions including deep brain stimulation (DBS) and capsulotomy have been demonstrated effective for refractory obsessive-compulsive disorder (OCD), although treatment-shared/-specific network mechanisms remain largely unclear. We retrospectively analyzed resting-state fMRI data from three cohorts: a cross-sectional dataset of 186 subjects (104 OCD and 82 healthy controls), and two longitudinal datasets of refractory patients receiving ventral capsule/ventral striatum DBS (14 OCD) and anterior capsulotomy (27 OCD). We developed a machine learning model predictive of OCD symptoms (indexed by the Yale–Brown Obsessive Compulsive Scale, Y-BOCS) based on functional connectivity profiles and used graphic measures of network communication to characterize treatment-induced profile changes. We applied a linear model on 2 levels treatments (DBS or capsulotomy) and outcome to identify whether pre-surgical network communication was associated with differential treatment outcomes. We identified 54 functional connectivities within fronto-subcortical networks significantly predictive of Y-BOCS score in patients across 3 independent cohorts, and observed a coexisting pattern of downregulated cortico-subcortical and upregulated cortico-cortical network communication commonly shared by DBS and capsulotomy. Furthermore, increased cortico-cortical communication at ventrolateral and centrolateral prefrontal cortices induced by DBS and capsulotomy contributed to improvement of mood and anxiety symptoms, respectively (p < 0.05). Importantly, pretreatment communication of ventrolateral and centrolateral prefrontal cortices were differentially predictive of mood and anxiety improvements by DBS and capsulotomy (effect sizes = 0.45 and 0.41, respectively). These findings unravel treatment-shared and treatment-specific network characteristics induced by DBS and capsulotomy, which may facilitate the search of potential evidence-based markers for optimally selecting among treatment options for a patient.

包括深部脑刺激 (DBS) 和囊切开术在内的神经外科干预已被证明对难治性强迫症 (OCD) 有效，尽管治疗共享/特定的网络机制在很大程度上仍不清楚。我们回顾性分析了三个队列的静息态 fMRI 数据：186 名受试者（104 名强迫症患者和 82 名健康对照者）的横截面数据集，以及接受腹囊/腹侧纹状体 DBS（14 名强迫症）和前囊切开术的难治性患者的两个纵向数据集（27 强迫症）。我们基于功能连接配置文件开发了一种预测 OCD 症状的机器学习模型（由 Yale-Brown 强迫症量表 Y-BOCS 索引），并使用网络通信的图形测量来表征治疗引起的配置文件变化。我们对 2 级治疗（DBS 或囊切开术）和结果应用线性模型，以确定术前网络通信是否与不同的治疗结果相关。我们在 3 个独立队列的患者中确定了额皮质下网络中的 54 个功能连接，可显着预测 Y-BOCS 评分，并观察到 ​​DBS 和囊切开术通常共享的下调皮质-皮质下和上调皮质-皮质网络通信的共存模式。此外，由 DBS 和囊切开术诱导的腹外侧和中央外侧前额叶皮质的皮质-皮质通讯增加分别有助于改善情绪和焦虑症状（我们在 3 个独立队列的患者中确定了额皮质下网络中的 54 个功能连接，可显着预测 Y-BOCS 评分，并观察到 ​​DBS 和囊切开术通常共享的下调皮质-皮质下和上调皮质-皮质网络通信的共存模式。此外，由 DBS 和囊切开术诱导的腹外侧和中央外侧前额叶皮质的皮质-皮质通讯增加分别有助于改善情绪和焦虑症状（我们在 3 个独立队列的患者中确定了额皮质下网络中的 54 个功能连接，可显着预测 Y-BOCS 评分，并观察到 ​​DBS 和囊切开术通常共享的下调皮质-皮质下和上调皮质-皮质网络通信的共存模式。此外，由 DBS 和囊切开术诱导的腹外侧和中央外侧前额叶皮质的皮质-皮质通讯增加分别有助于改善情绪和焦虑症状（p  < 0.05）。重要的是，腹外侧和中央外侧前额叶皮质的治疗前交流对 DBS 和囊切开术的情绪和焦虑改善有不同的预测作用（效应量分别为 0.45 和 0.41）。这些发现揭示了由 DBS 和囊切开术引起的治疗共享和治疗特异性网络特征，这可能有助于寻找潜在的循证标记，以便为患者选择最佳治疗方案。