Leveraging Longitudinal DBS Recordings to Probe Pharmacological Mechanisms: Investigating the Role of Orexin Antagonists on Extended Amygdala Activity.
Jason Raj, Emma Anderson, Sneha Ray et al.
✦ AI-curated · Sources linked
Case in brief
A patient with severe, treatment-refractory obsessive-compulsive disorder and comorbid insomnia had beta activity recorded longitudinally from the bed nucleus of the stria terminalis (BNST) using implanted deep brain stimulation electrodes. During nighttime use of a sleep-promoting orexin antagonist, dose reductions were associated with a significant overnight increase in the BNST beta biomarker of arousal. The report used recordings collected in naturalistic settings to relate a medication change to circuit activity, illustrating how longitudinal intracranial signals can be studied alongside pharmacological interventions.
What made this case unusual
The case linked nighttime dose reductions of an orexin antagonist with increased overnight BNST beta activity, providing a human intracranial measure of a medication-associated change in arousal-related circuitry.
Diagnostic / clinical pearl
Longitudinal DBS recordings can capture circuit-level changes associated with pharmacological interventions in naturalistic settings, including changes in BNST beta activity during orexin-antagonist dose reductions.
Why it matters
The observation supports the potential use of intracranial biomarkers to investigate pharmacological mechanisms in individual patients.