339 Intolerance to Acute DBS Cessation Is Associated With Distinct Lead Placement and White Matter Engagement

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INTRODUCTION: Deep brain stimulation (DBS) of the ventral capsule and ventral striatum (VC/VS) is an effective treatment for obsessive-compulsive disorder (OCD) refractory to conventional therapies. While stimulation-induced side effects are well documented, adverse effects from abrupt stimulation cessation following chronic DBS are poorly characterized. METHODS: We retrospectively analyzed eleven patients treated with DBS to the VC/VS who experienced stimulation cessation during programming or research tasks. Based on behavioral responses, we classified patients as “tolerant” or “intolerant.” Using Lead-DBS, we reconstructed electrode locations in MNI space and compared active contact locations (A-B). We computed volumes of tissue activated (VTA) to assess overlap with limbic structures and performed tractography seeded from VTAs. We compared normalized streamline counts from VTA to MICCAI-atlas regions using Mann-Whitney U tests and overall connectivity through a permutation-based multivariate ANOVA (PERMANOVA). RESULTS: Six of eleven patients (55%) were intolerant to acute stimulation cessation, exhibiting symptoms such as anxiety, breathlessness, and tearfulness. No difference was observed in response rate between groups (p = 0.52). Intolerant patients had significantly more posterior active contacts than tolerant patients (p = 0.016, C-E). VTA overlap with limbic structures, including the hypothalamus, bed nucleus of the stria terminalis, anterior commissure, and fornix, showed no group differences. However, tractography analyses revealed a significant group difference in overall VTA connectivity between tolerant and intolerant patients (p = 0.030). Tolerant patients demonstrated greater VTA connectivity to the ventromedial prefrontal cortex (p = 0.003), gyrus rectus (p = 0.009), orbitofrontal cortex (p = 0.027), and putamen (p = 0.034). Intolerant patients demonstrated greater connectivity to the ventral diencephalon (p = 0.016) and cerebellum (p = 0.034). CONCLUSIONS: Lead placement was significantly more posterior in patients intolerant to abrupt stimulation cessation. Although VTA overlap with surrounding grey matter structures showed no group differences, differences in VTA connectivity to distal structures suggest differential engagement of white matter tracts.

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