Brain structural abnormalities in behavior therapy-resistant obsessive-compulsive disorder revealed by voxel-based morphometry

Abstract

BackgroundAlthough several functional imaging studies have demonstrated that behavior therapy (BT) modifies the neural circuits involved in the pathogenesis of obsessive-compulsive disorder (OCD), the structural abnormalities underlying BT-resistant OCD remain unknown.MethodsIn this study, we examined the existence of regional structural abnormalities in both the gray matter and the white matter of patients with OCD at baseline using voxel-based morphometry in responders (n=24) and nonresponders (n=15) to subsequent BT. Three-dimensional T1-weighted magnetic resonance imaging was performed before the completion of 12 weeks of BT.ResultsRelative to the responders, the nonresponders exhibited significantly smaller gray matter volumes in the right ventromedial prefrontal cortex, the right orbitofrontal cortex, the right precentral gyrus, and the left anterior cingulate cortex. In addition, relative to the responders, the nonresponders exhibited significantly smaller white matter volumes in the left cingulate bundle and the left superior frontal white matter.ConclusionThese results suggest that the brain structures in several areas, including the orbitofrontal cortex, anterior cingulate cortex, and cingulate bundles, are related to the lack of a response to BT in patients with OCD. The use of a voxel-based morphometry approach may be advantageous to understanding differences in brain abnormalities between responders and nonresponders to BT.

Aberrant functional connectivity density in patients with treatment-refractory obsessive-compulsive disorder: a pilot study

“…37–45 The reduced connections in this pivotal region impair information communication ability, thereby impairing the modulation of emotion, cognitive, and memory processing and leading to more complex and more serious obsessive-compulsive symptoms. 9,33,35,46–54 Overall, our findings suggest that decreased gFCD may be a specific brain-pathological characteristic of TROCD. The impaired information communication processing caused by decreased gFCD in the left middle temporal gyrus may cause OCD to become refractory to treatment.…”

Deep brain stimulation response in obsessive–compulsive disorder is associated with preoperative nucleus accumbens volume

“…While recent studies showed that treatment response might improve with diffusion magnetic resonance imaging (MRI) guided DBS targeting ( Baldermann et al, 2019 , Coenen et al, 2017 , Liebrand et al, 2019 ), it is unlikely that all patients will become responders in the future. Since OCD has been associated with various structural brain abnormalities ( Boedhoe et al, 2017 , Gan et al, 2017 , Hashimoto et al, 2014 ), differences in (individual) brain structure might be used to predict treatment response. Multiple studies used structural MRI data to predict treatment outcome in OCD (e.g., ( Hashimoto et al, 2014 , Yun et al, 2015 )), but few studies examined neural biomarkers for treatment-resistant OCD ( Dunlop et al, 2016 , Van Laere et al, 2006 ).…”

“…Since OCD has been associated with various structural brain abnormalities ( Boedhoe et al, 2017 , Gan et al, 2017 , Hashimoto et al, 2014 ), differences in (individual) brain structure might be used to predict treatment response. Multiple studies used structural MRI data to predict treatment outcome in OCD (e.g., ( Hashimoto et al, 2014 , Yun et al, 2015 )), but few studies examined neural biomarkers for treatment-resistant OCD ( Dunlop et al, 2016 , Van Laere et al, 2006 ). Nevertheless, the potential benefits of a reliable biomarker for DBS response are substantial.…”