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Neural biomarkers could reduce this uncertainty by forecasting treatment outcome, providing early evidence of therapeutic engagement, and objectively tracking clinical response. We analyzed nearly 120,000 patient-hours of chronic intracranial recordings from 24 patients undergoing ventral capsule\/ventral striatum deep brain stimulation for treatment-resistant obsessive-compulsive disorder. Before stimulation initiation, circadian neural features distinguished eventual responders from non-responders. Within the first two weeks of therapy, reductions in neural predictability differentiated eventual 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. Together, these findings establish a framework for neural biomarkers spanning the course of DBS therapy: forecasting treatment response before stimulation, detecting early therapeutic engagement after activation, and longitudinally monitoring clinical response.<\/jats:p>","DOI":"10.64898\/2026.09.18.26363320","type":"posted-content","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T19:35:21Z","timestamp":1790019321000},"source":"Crossref","is-referenced-by-count":0,"title":["Chronic intracranial neural dynamics forecast treatment response and therapeutic engagement during deep brain stimulation for OCD"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8400-4390","authenticated-orcid":false,"given":"Jeffrey","family":"Zhou","sequence":"first","affiliation":[{"name":"Rice University, Department of Bioengineering, Houston, TX"},{"name":"Baylor College of Medicine, Department of Neurosurgery, Houston, 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