Abstract
Background
Little is known about the neural mechanism and response variability underlying neurosurgical
interventions for intractable obsessive-compulsive disorder (OCD).
Methods
Of 81 OCD patients screened for capsulotomy identified in our institutional database,
36 patients with clinical assessment before and after capsulotomy and imaging data
(9 of 36 patients without postoperative imaging data used as an independent test group),
and 29 healthy control subjects were retrospectively recruited. Twenty of 36 patients
(56%) responded to the lesion procedure (determined as a ≥35% reduction in Yale-Brown
Obsessive Compulsive Scale [Y-BOCS] score). Seed-based (i.e., ventral and dorsal caudate,
medial dorsal thalamus, and ventral and dorsal putamen) resting-state functional connectivity
was used to examine alterations in frontostriatal circuitry after capsulotomy.
Results
The Y-BOCS score significantly decreased (p < .001) after capsulotomy in OCD patients. Functional connectivity between the ventral
striatum/nucleus accumbens and the dorsal anterior cingulate cortex was reduced (p < .05, corrected) after the surgical procedure. Moreover, change in connectivity
significantly correlated with alteration in Y-BOCS score (r = .41, p = .033). In addition, preoperative connectivity between the dorsal caudate and the
dorsal anterior cingulate cortex could differentiate nonresponders from responders
and predict changes in Y-BOCS score (R2 = .23, F1,25 = 7.56, p = .011), which was generalized in an independent test group.
Conclusions
We demonstrated that restoration of ventral frontostriatal connectivity was associated
with clinical improvement in refractory OCD, suggesting a therapeutic mechanism of
capsulotomy. Moreover, preoperative variations in dorsal frontostriatal connectivity
predicted clinical response, which may offer a predictor of treatment outcome.
Keywords
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Article info
Publication history
Published online: April 21, 2018
Accepted:
April 11,
2018
Received in revised form:
April 9,
2018
Received:
December 11,
2017
Footnotes
DY and CZ contributed equally to this work. ZW and BS contributed equally to this work as joint senior authors.
Identification
Copyright
© 2018 Society of Biological Psychiatry.
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Access this article on ScienceDirectLinked Article
- Are We Ready for Individualized Target Planning of Ablative Procedures in Intractable Obsessive-Compulsive Disorder?Biological PsychiatryVol. 84Issue 12
- PreviewObsessive-compulsive disorder (OCD) has a prevalence of 2% to 3% worldwide (1). The World Health Organization ranks OCD as one of the ten most disabling conditions because of its early age of onset, chronicity, and high levels of clinical comorbidity, as well as the associated premature mortality, suicidality, reduced capacity to work, and impaired quality of life (1). A significant proportion of patients with OCD do not achieve an adequate response after appropriate first-line treatments (i.e., with serotonin reuptake inhibitors or behavioral therapy).
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