Brain activity associated with obsessive-compulsive disorder (OCD) has been recorded for the first time, potentially opening avenues for new, adaptive therapies.

Published last month in the journal Nature Medicine, the first-of-its-kind study recorded electrical signals in the brains of five people with OCD – an admittedly small sample size – in both clinical and at-home settings.

“This is the first time brain signals from participants with neuropsychiatric illness have been recorded chronically at home alongside relevant behavioral measures,” lead author Nicole Provenza of Brown University said in a statement. 

“Using these brain signals, we may be able to differentiate between when someone is experiencing OCD symptoms, and when they are not, and this technique made it possible to record this diversity of behavior and brain activity.”

OCD is a neurological condition affecting 2 percent of adults worldwide and can have major impacts on quality of life. Symptoms include intrusive thoughts and compulsive behaviors that can take many forms and are notoriously difficult to treat. An estimated 20 to 40 percent of people with OCD don’t respond to traditional treatments or drugs. 

However, an emerging therapy called deep brain stimulation (DBS) that involves planting electrodes in specific brain regions to deliver electrical stimulation has shown promise in over half of patients who don’t respond to other treatments. It is limited, however, by its inability to respond to changes in OCD symptoms. Currently, only a doctor can adjust the level of stimulation, hence the need for an adaptive DBS system.

The devices the team used to record brain activity were also capable of providing DBS and so could one day provide exactly that.

"OCD is a disorder in which symptom severity is highly variable over time and can be elicited by triggers in the environment," said senior author David Borton, also from Brown University.

"A DBS system that can adjust stimulation intensity in response to symptoms may provide more relief and fewer side effects for patients. But in order to enable that technology, we must first identify the biomarkers in the brain associated with OCD symptoms, and that is what we are working to do in this study."

By recording real-time data on behavioral activity – including facial expressions, body movements, and self-reported symptom intensity – alongside brain signals, the team was able to identify potentially OCD-linked neural biomarkers, which could be used in an adaptive DBS system. These were identified in the cortico-striatal-thalamo-cortical network, a brain pathway that controls habit formation, reward processing, and movement execution.

The research is very much in its early stages, and more studies with larger cohorts over longer periods of time are needed before adaptive DBS reaches its full potential. 

But, the researchers say, it’s a strong start in bettering our understanding and treatment of OCD.

“Our goal is to understand what those brain recordings are telling us and to train the device to recognize certain patterns associated with specific symptoms,” lead neurosurgeon Sameer Sheth from Baylor College of Medicine in Texas said. 

“The better we understand the neural signatures of health and disease, the greater our chances of using DBS to successfully treat challenging brain disorders like OCD.”