Supplementary Materials:
1. Supplemental text
2 Tables S1-3
3. Figure S1
1. STN localization
All patients suffering from OCD and referred to our institution are operated under the same surgical
procedure routinely used for the implantation of DBS leads in patients with movement disorders 30.
Briefly, 2 days before the surgical implantation, a stereotactic digital televentriculography (Pixray;
BioScan, Geneva, Switzerland) is performed under general anaesthesia. Then, for each patient, T1- and
T2-contrasted three-dimensional cerebral magnetic resonance imaging (MRI) scans are obtained in
stereotactic conditions before the surgical implantation of the leads. The targeting of anterior STN is
performed on the ventriculographic X-ray fused with the MRI scans using stereotactic imaging software
(Voxim; IVS Solutions, Chemnitz, Germany). In patients with PD, the following coordinates are
frequently used to target the STN: 6/12 of the anterior-posterior commissural (AC-PC) length posterior to
the AC, 12mm lateral to the midline, and 3 mm below the AC-PC line. In patients with OCD, the anterior
STN is targeted 2 mm anterior and 1 mm medial to the previous target. It is then adjusted during surgical
implantation by using multiunit recordings. In patients with OCD, the anterior STN is identified by the
lack of sensorimotor side effects such as contralateral paresthesias or motor contractions induced by
microstimulations. STN location was confirmed in six patients (P1-P6) by a combined approach that
included intraoperative microelectrode recordings, direct micro and macro-stimulation and postoperative
stereotactic MRI (Fig. S1) with fusion to the preoperative MRI (cases 1–6). In case 7, STN was localized
using preoperative MRI and direct macrostimulation. The final DBS electrode coordinates are reported in
Table S2 and Figure S1.
2. Supplemental Table S1-3
Table S1. Clinical characteristics of OCD patients at time of surgery. OCD type (1;2;3) corresponded to
the main type of symptom observed: contamination/cleaner (1), doubt/checker (2) and miscellaneous
OCD + repeating (3); YBOCS = Yale-Brown Obsessive Compulsive Scale (with Obsessions +
Compulsions subscores); GAF = Global Assessment of Functioning; CGI = Clinical Global Impression;
SNRI = serotonin and norepinephrine reuptake inhibitors; SRI = serotonin reuptake inhibitors; FGA =
first-generation antipsychotics; SGA= second-generation antipsychotics.
Clinical scales
Sex
Age,
years
Duration of
symptoms,
years
OCD
type
YBOCS
P1
M
36
17
1
P2
F
38
11
P3
F
40
P4
F
P5
Medication, Total Daily Dose (mg)
CGI
GAF
17+15
5
40
1
18+18
6
32
15
1
19+17
6
34
54
22
2
17+16
5
30
M
34
13
2
16+16
6
35
P6
M
27
10
3
17+17
6
30
P7
F
30
23
2
16+18
6
35
SNRI and
SRI
paroxetine
40mg
sertraline
100mg
fluvoxamine
200mg
clomipramine
75mg
paroxetine
50mg
clomipramine
187,5mg
sertraline
150mg
Venlafaxine
75mg
FGA and
SGA
Other
Medications
clonazepam 4mg
gabapentin 600mg
clonazepam 3mg
lorazepam 3mg
zopiclone 7,5mg
cyamemazine
150mg
amisulpride
300mg
oxazepam 150mg
Levothyrox 125µg
Table S2. Summary of task-responsive and non-responsive (NR) units in the associative STN. Each
line corresponds to one unit (Su and MU; for example, c26 corresponds to a single cell 26 whereas
MU9 corresponds to a multi-unit 9). For each unit type (task responsive: GO, SS, US cells or nonresponsive cells, NR), each column describes the patient (Pat) that contributed to each recording,
the hemisphere recorded (STN side, left L and right, R), the recording depth (in mm below CA-CP
line) and the baseline firing rate of this unit (computed during visual fixation epochs). Note that
most of the NR units showed no response at all to task events (79 %) whereas the remaining 21 %
were modulated non-specifically by different trial-types (i.e., these units did not fulfill criteria used
to define SS, US and GO units).
Pat
Side
Depth
Cell Type
cell number
FR (Hz)
P1
P1
P1
P2
P2
P3
P4
P5
P5
P6
P1
P2
P2
P2
P3
P3
P3
P4
P5
P6
P1
P1
P2
P2
P2
P2
P4
P4
P5
P6
P6
P6
P1
P1
P1
P1
P1
P1
P2
P2
P2
P2
P2
P2
P2
P2
P2
P2
P2
R
L
R
L
L
L
R
L
L
L
L
L
R
R
L
L
L
R
R
R
R
L
R
R
L
L
R
R
R
L
R
L
R
R
L
L
R
R
L
L
L
L
L
R
R
L
L
L
R
-3,751
-7,718
-2,535
-5,484
-8,258
-4,468
-5,395
-5,025
-5,025
-7,240
-6,536
-5,484
-3,769
-4,899
-4,468
-5,988
-4,468
-4,978
-6,359
-7,086
-2,535
-7,718
-3,769
-4,899
-7,429
-8,258
-6,146
-4,978
-4,673
-4,251
-6,247
-6,472
-2,535
-2,535
-5,934
-7,718
-3,751
-3,751
-5,484
-6,410
-6,410
-6,410
-7,429
-4,899
-4,899
-7,429
-7,429
-8,258
-3,769
GO
GO
GO
GO
GO
GO
GO
GO
GO
GO
SS
SS
SS
SS
SS
SS
SS
SS
SS
SS
US
US
US
US
US
US
US
US
US
US
US
US
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
c26
c30
MU9
MU13
MU19
c43
MU3
C5
C6c
c16
c28
c31
c37
c40
c45
c46
MU22
C2
MU5
MU7
c25
MU12
c38
c42
MU16
MU18
C3
MU1
c7
c13
c18
MU6
c23
c24
c27
c29
MU10
MU11
c32
c33
c34
c35
c36
c39
c41
MU14
MU15
MU17
MU20
18,4
49,1
9,0
2,7
11,8
16,3
36,4
26,7
53,5
39,8
32,0
6,6
29,3
3,4
13,1
4,1
4,2
21,0
29,5
36,2
7,4
32,1
13,7
11,3
3,8
7,6
2,8
13,5
27,8
14,9
8,3
38,3
17,0
10,2
30,6
33,4
35,8
19,1
8,1
24,3
25,3
16,8
15,0
14,2
10,5
37,9
36,6
41,1
7,7
P2
P3
P3
P3
P3
P3
P3
P4
P4
P4
P4
P5
P5
P5
P5
P5
P5
P5
P6
P6
P6
P6
P6
P6
P6
P6
R
L
R
R
R
R
L
L
R
R
R
R
R
R
L
L
R
R
L
L
L
R
R
R
R
R
-4,899
-4,468
-6,183
-6,183
-6,183
-6,183
-5,988
-4,940
-6,146
-5,395
-6,146
-5,334
-6,359
-6,359
-5,025
-5,025
-5,334
-5,334
-5,768
-5,768
-7,240
-6,962
-6,962
-7,086
-7,409
-7,409
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
MU21
c44
c47
c48
c49
c50
MU23
C1
C4
MU2
MU4
c10
c11
c12
C6
C6b
c8
c9
c14
c15
c17
c19
c20
c21
c22
MU8
14,9
17,6
16,7
32,6
19,1
13,2
14,4
11,5
15,3
6,3
6,7
24,2
3,5
27,8
29,6
21,9
32,9
5,1
24,6
27,2
9,4
26,4
20,4
10,5
20,2
20,1
Table S3. Final DBS electrode coordinates where the maximal level of 15-30 Hz activity was recorded
during the stop-signal task. For each side, the coordinates of the two adjacent electrode contacts defining
the bipole are shown. Coordinates are given in millimetres relative to each patient ventricular landmarks
(Anterior/posterior Commissures (AC, PC) and midline). These coordinates were determined offline
using the televentriculography and the final intraoperative X-Ray scan, as described previously 1, 30, 31. X
coordinates: laterality relative to the midline. Z coordinates: depth relative to the AC-PC line. Y
coordinates: anteriority relative to the anterior border of PC. By convention, DBS contacts are labelled
contacts 0,1,2,3 on the right side and contacts 4,5,6,7 on the left side.
P1
P1
P1
P1
P2
P2
P2
P2
P3
P3
P3
P3
P4
P4
P4
P4
P5
P5
P5
P5
P6
P6
P6
P6
P7
P7
P7
P7
Left
Left
Right
Right
Left
Left
Right
Right
Left
Left
Right
Right
Left
Left
Right
Right
Left
Left
Right
Right
Left
Left
Right
Right
Left
Left
Right
Right
DBS
contact
5
6
1
2
6
7
1
2
6
7
1
2
6
7
2
3
5
6
0
1
5
6
2
3
5
6
1
2
X
(mm)
9,24
9,82
-8,89
-9,62
9,75
10,50
-8,89
-9,62
9,36
10,12
-10,09
-10,64
9,35
9,91
-10,84
-11,59
9,59
10,41
-8,15
-8,89
7,66
8,22
-10,84
-11,78
9,39
9,88
9,22
9,63
Y
(mm)
10,85
12,10
9,30
10,62
12,58
13,55
9,30
10,62
10,40
11,36
11,60
12,75
12,37
12,74
12,37
12,74
13,68
14,37
8,18
9,30
11,41
12,48
13,13
14,20
11,19
12,48
11,58
12,79
Z
(mm)
-3,22
-1,32
-3,22
-1,70
-1,87
0,11
-3,22
-1,70
-1,64
-0,04
-3,31
-1,67
-3,39
-1,37
-3,39
-1,37
-3,55
-1,90
-4,71
-3,22
-4,21
-2,50
-2,70
-1,00
-3,49
-1,87
-3,74
-2,06
3. Figure S1
Figure S1. Final DBS electrode location superimposed on the preoperative MRI of each patient. Yellow
spheres: individual DBS contacts. RN: red nucleus; GP: globus pallidus; SN: Substantia Nigra; CD:
caudate nucleus; STN: subthalamic nucleus.