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The OCD network comprises different sub-networks with homeostatic functions, altered under disease and modifiable with DBS. Connectomic analyses of DBS data sets have defined fiber selections explaining anti-OCD efficacy. This is a retrospective stimulation and outcome derived anatomical overlay analysis of 26 TR-OCD patients who received DBS at two academic centers. Grenoble, 14 anteromedial subthalamic nucleus (amSTN); Freiburg, 12 superolateral medial forebrain bundle (slMFB). Yale-Brown Obsessive Compulsive Scale improvement at 24 months served as outcome parameter. Structural proximity and outcomes were correlated using individual volumes of activated tissue for STN, slMFB, ORT (average OCD response tract) and further structures based on atlases or established connectomes. Connectomes (slMFB, ORT) were inspected for structural congruences. Normative connectomic data served to investigate cortical fiber penetration for the two target regions. Cortical sub-network conjugations were evaluated as peak levels. Our analyses revealed that ORT represents a fiber selection from the slMFB. DBS of amSTN and slMFB each address distinctive sub-networks while deep amSTN DBS can also address slMFB. Sub-network conjugations project amongst other regions onto the dorsomedial prefrontal cortex (dmPFC). The average ORT fiber selection is an integral part of the generic slMFB. Anti-OCD effects of amSTN DBS are not entirely explained by ORT overlay. The slMFB is dispersed and encompasses all OCD sub-networks and might qualify as a common DBS target when stimulated close to the ventral tegmental area. The dmPFC emerges as an interesting conjugation\/hub between OCD sub-networks.<\/jats:p>","DOI":"10.1038\/s41380-025-03008-x","type":"journal-article","created":{"date-parts":[[2025,4,6]],"date-time":"2025-04-06T01:56:21Z","timestamp":1743904581000},"page":"4274-4285","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Deconstructing a common pathway concept for Deep Brain Stimulation in the case of Obsessive-Compulsive Disorder"],"prefix":"10.1038","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1703-6283","authenticated-orcid":false,"given":"Volker A.","family":"Coenen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mircea","family":"Polosan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0612-9692","authenticated-orcid":false,"given":"Thomas E.","family":"Schl\u00e4pfer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7930-1476","authenticated-orcid":false,"given":"Stephan","family":"Chabardes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dora M.","family":"Meyer-Doll","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Czornik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oskan","family":"S\u00fcr\u00fcc\u00fc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5851-9268","authenticated-orcid":false,"given":"Juan Carlos","family":"Baldermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7322-1195","authenticated-orcid":false,"given":"Dominique","family":"Endres","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horst","family":"Urbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1691-546X","authenticated-orcid":false,"given":"Peter C.","family":"Reinacher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5881-6043","authenticated-orcid":false,"given":"Alexander","family":"Rau","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0187-2252","authenticated-orcid":false,"given":"M\u00e1t\u00e9 D.","family":"D\u00f6br\u00f6ssy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2836-0046","authenticated-orcid":false,"given":"Bastian E. 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Unrelated: VAC receives a collaborative grant from BrainLab (Munich, Germany). He is a consultant for Ceregate (Munich, Germany), Cortec (Freiburg, Germany) and Inbrain (Barcelona, Spain). He has an ongoing IIT with Boston Scientific (USA) and has received personal honoraria and travel support for lecture work from Boston Scientific (USA), ALEVA, UNEEG and PRECISIS. Unrelated: MP has received financial support for investigator-initiated trials from Boston Scientific and honoraria for lecturing or consultation from Lundbeck. Unrelated: SC has received honoraria for consultation from Medtronic, Boston Scientific. Unrelated: PCR has received research support from Else Kr\u00f6ner-Fresenius Foundation, Fraunhofer Foundation (ATTRACT), German Ministry for Economic Affairs and Energy, and Medical Faculty of the University of Freiburg. He has received personal honoraria for lectures or advice from Fraunhofer Foundation and is a consultant for Boston Scientific, Brainlab, and Inomed. DMD receives research support from Evangelisches Studienwerk e.V. and Wissenschaftliche Gesellschaft Freiburg im Breisgau. JCB is funded by the Else-Kr\u00f6ner-Fresenius-Stiftung (2022_EKES.23). BEAS received a research grant from Ceregate (Munich, Germany) and received honoraria as a consultant for Precisis, Heidelberg, both unrelated to this work. All other authors declare no conflicts of interest.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"a) All methods were performed in accordance with relevant guidelines and regulations. b) Freiburg: Patients with TR-OCD who previously had received bilateral slMFB-DBS were selected for analysis, if they gave informed consent to our DBS registry that adheres to the principles of the Helsinki Declaration and received approval from institutional review board (Ethics Committee of Freiburg University; no.21-1274). Grenoble: The publication of results had previously been discussed [\n                      \n                      ] and waived on the basis of a national committee decision: Comit\u00e9 consultatif National d\u2019ethique. La neurochirurgie fonctionnelle D affectionspsychiatriques severes 2002. c) Freiburg: Patients gave written informed consent. Grenoble: Written consent was obtained for surgery. For publication, based on national guidelines no written consent was necessary (see b).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}}]}}