Chronic intracranial neural dynamics forecast treatment response and therapeutic engagement during deep brain stimulation for OCD

The study analyzed nearly 120,000 hours of chronic intracranial recordings from 24 patients undergoing deep brain stimulation in the ventral capsule and ventral striatum for treatment-resistant obsessive-compulsive disorder. Before stimulation initiation, circadian neural features distinguished patients who responded to treatment from non-responders. Within the first two weeks of therapy, reduction in neural predictability differentiated responders from non-responders and correlated with the magnitude of subsequent symptom improvement months before stable clinical response was achieved. During chronic treatment, neural predictability tracked clinical response state. The findings establish a framework for neural biomarkers throughout the course of DBS therapy: forecasting treatment response before stimulation, detecting early therapeutic engagement after activation, and longitudinally monitoring clinical response.