A functional neuroimaging investigation of deep brain stimulation in patients with obsessive–compulsive disorder

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  • 1 Division of Psychiatric Neuroscience Research and Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, Massachusetts; Departments of Psychiatry and Neurosurgery, The Cleveland Clinic, Cleveland, Ohio; Department of Neurosurgery, Brown Medical School, Providence, Rhode Island; Division of Nuclear Medicine, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Department of Pharmacology and Physiology, University of Rochester School of Medicine, Rochester, New York; Medtronic Neurological, Minneapolis, Minnesota; and Department of Psychiatry and Behavioral Sciences, Butler Hospital and Brown Medical School, Providence, Rhode Island
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Object

Deep brain stimulation (DBS) of the ventral [anterior internal] capsule/ventral striatum (VC/VS) is under investigation as an alternative to anterior capsulotomy for severe obsessive–compulsive disorder (OCD). In neuroimaging studies of patients with OCD, dysfunction in the orbitofrontal and anterior cingulate cortex, striatum, and thalamus has been identified; and modulation of activity in this circuit has been observed following successful nonsurgical treatment. The purpose of the current study was to test hypotheses regarding changes in regional cerebral blood flow (rCBF) during acute DBS at the VC/VS target in patients with OCD who were participating in a clinical DBS trial.

Methods

Six patients enrolled in a DBS trial for OCD underwent positron emission tomography to measure rCBF; the rCBF measured during acute DBS at high frequency was then compared with those measured during DBS at low frequency and off (control) conditions. On the basis of neuroanatomical knowledge about the VC/VS and neuroimaging data on OCD, the authors predicted that acute DBS at this target would result in modulation of activity within the implicated frontal–basal ganglia–thalamic circuit. Data were analyzed using statistical parametric mapping.

In a comparison of acute high-frequency DBS with control conditions, the authors found significant activation of the orbitofrontal cortex, anterior cingulate cortex, striatum, globus pallidus, and thalamus.

Conclusions

Acute DBS at the VC/VS target is associated with activation of the circuitry implicated in OCD. Further studies will be necessary to replicate these findings and to determine the neural effects associated with chronic VC/VS DBS. Moreover, additional data are needed to investigate whether pretreatment imaging profiles can be used to predict a patient’s subsequent clinical response to chronic DBS.

Abbreviations used in this paper: ACC = anterior cingulate cortex; AC–PC = anterior commissure–posterior commissure; CT = computerized tomography; DBS = deep brain stimulation; FWHM = fullwidth at half maximum; MNI = Montreal Neurological Institute; MR = magnetic resonance; OCD = obsessive–compulsive disorder; OFC = orbitofrontal cortex; PET = positron emission tomography; rCBF = regional cerebral blood flow; ROI = region of interest; SSRI = selective serotinin reuptake inhibitor; VC = ventral [anterior internal] capsule; VS = ventral striatum; Y-BOCS = Yale-Brown Obsessive Compulsive Scale.

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Contributor Notes

Address reprint requests to: Scott L. Rauch, M.D., Division of Psychiatric Neuroscience Research and Neurotherapeutics, Department of Psychiatry, Massachusetts General Hospital, Bldg. 149, 13th Street, CNY-2, Charlestown, Massachusetts 02129. email: rauch@psych.mgh.harvard.edu.
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