Fig. 4: Case illustration of subject-specific NAc shell DBS.
A Personalized NAc circuit-based subregions were defined by probabilistic tractography in high-resolution diffusion MRI and implanted with DBS electrodes in a 56-year-old female with severe obesity in our first-in-human clinical trial of NAc DBS for loss of control eating. B The bilateral NAc subregions with the most robust tractography-defined vmPFC structural connections (red overlay, NAc shell) were encompassed by the two distal-most electrode contact artifacts from co-registered CT scan (white overlay). C During 12 weeks of active stimulation, the participant sustained a statistically significant decrease in the number of weekly episodes of uncontrolled eating (Friedman’s χ2 (3) = 7.86, p = 0.049, two-tailed); this difference became significant in comparison to baseline levels from weeks 5–8 of active stimulation onwards (p < 0.05, Dunn’s test, two-tailed, FDR-corrected). D, E In the 12-week period, the participant also had a decrease in the ELOCS-18 frequency (baseline, BL: 12.9 episodes per week; weeks 9–12: 3 episodes per week) and severity (baseline: 5.6; weeks 9–12: 3.4) scores. F After 3 months, the participant also sustained a decreased in body weight (weight at baseline: 141.5 kg; 3-month follow-up: 139.2) and BMI (baseline: 48.9; BMI after 3-month follow-up: 48.1). *p < 0.05.
