Metabolic Imaging of Bilateral Anterior Capsulotomy in Refractory Obsessive Compulsive Disorder: an FDG PET Study

Zuo, Chuantao; Ma, Yilong; Sun, Bomin; Peng, Shichun; Zhang, Huiwei; Eidelberg, David; Guan, Yihui

doi:10.1038/jcbfm.2013.23

Cited by 50 publications

(43 citation statements)

References 35 publications

(48 reference statements)

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“…Zuo et al also showed a metabolic decrease in the ACC after capsulotomy in OCD patients (12). The anterior cingulate has been described as an important region in both OCD and MD symptomatology.…”

Section: Discussionmentioning

confidence: 94%

“…There was no overlap with the frontal regions of decreased metabolism at baseline. Chronic successful treatment has been associated with a decrease in prefrontal and orbitofrontal metabolism in several studies (12,30,31). This decrease correlated with improvement of OCD symptoms in several studies (8,30).…”

Section: Discussionmentioning

confidence: 97%

“…Bussato et al (32) described an improvement in Y-BOCS score to be related to an increase in perfusion in the left cuneus. In patients after capsulotomy, increases in the right middle occipital gyrus related to Y-BOCS improvement (12). Another study showed metabolic increases in the cuneus after successful pharmacologic treatment of OCD (36).…”

Section: Discussionmentioning

confidence: 99%

“…Both regions have been extensively documented to be core structures in the CSPTC. Zuo et al showed a metabolic decrease in these structures after capsulotomy in OCD patients (12), and a trend toward a metabolic decrease in the MD thalamus was shown in a previous pilot study after DBS (11). Other studies have also noted decreased activity in these regions after successful pharmacologic or behavioral treatment of OCD (28,30,31), emphasizing the importance of these regions in treatment response of OCD.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Zuo et al assessed glucose metabolic changes in 8 patients after capsulotomy and also reported decreased metabolism in the prefrontal cortex and anterior cingulate cortex (ACC) but increases in the precentral and lingual gyri. Clinical improvement correlated with metabolic changes in the right and left dorsal ACC and in the right middle occipital gyrus (12).…”

mentioning

confidence: 87%

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Differences in Metabolic Network Modulation Between Capsulotomy and Deep-Brain Stimulation for Refractory Obsessive-Compulsive Disorder

et al. 2014

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Around 7%-10% of patients with obsessive-compulsive disorder (OCD) are refractory to first-line treatment. Neurosurgical approaches are available such as capsulotomy or deep-brain stimulation (DBS). There is strong evidence for central involvement of the corticostriatopallidothalamocortical (CSPTC) circuit in OCD, but the exact mechanism through which these interventions lead to clinical improvement and potential differences in network modulation are not fully understood. Methods: In total, 13 capsulotomy patients (aged 29-59 y, 10 men and 3 women) and 16 DBS patients (aged 25-56 y, 6 men and 10 women) were prospectively included. 18 F-FDG PET was performed before and after capsulotomy and before and after DBS in both stimulation-on and stimulation-off conditions. Presurgical scans were compared with scans of healthy volunteers using SPM8 and global scaling, and metabolic changes after DBS were compared with changes after capsulotomy. Correlations with clinical improvements were investigated using the Yale-Brown ObsessiveCompulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HAM-D). Results: Both groups had similar pretreatment clinical morbidity as assessed by Y-BOCS and the Hamilton Depression Rating Scale. Preoperative superior frontal and supplementary motor cortex hypometabolism was common to both patient groups, and the subgenual anterior cingulate, occipital cortex (cuneus), and posterior cerebellum were relatively hypermetabolic. Postoperative metabolic decreases were common to both interventions in the anterior cingulate and the prefrontal and orbitofrontal cortices. Compared with DBS, capsulotomy resulted in more intense metabolic changes, with additional significant decreases in the mediodorsal thalamus, caudate nucleus, and cerebellum as well as increases in the precuneus and the fusiform and lingual gyrus. The stimulation-off condition of DBS patients showed no significant differences from the preoperative state. Improvement in Y-BOCS scores correlated with metabolic changes in the occipital cortex. Baseline metabolism in the subgenual anterior cingulate and superior temporal cortices were related to postoperative improvement of depressive symptoms. Conclusion: Capsulotomy and DBS lead to similar clinical improvement and similar metabolic network changes in the CSPTC circuit, with a prominent role for the subgenual anterior cingulate and other core structures of the CSPTC. However, metabolic changes are more pronounced and extended in capsulotomy than in DBS. Furthermore, cortical regions outside the CSPTC may also play an important role in OCD symptomatology.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 87%

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Differences in Metabolic Network Modulation Between Capsulotomy and Deep-Brain Stimulation for Refractory Obsessive-Compulsive Disorder

et al. 2014

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Nuclear medicine in neuromodulation

Rodman

Dougherty

2015

Neuromodulation in Psychiatry

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Altered spontaneous activity and effective connectivity of the anterior cingulate cortex in obsessive–compulsive disorder

Long

Luo

Guo

et al. 2020

J of Comparative Neurology

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Obsessive-compulsive disorder (OCD) is a disabling neuropsychiatric disorder whose neurobiological basis remains unclear. Magnetic resonance imaging (MRI) studies have reported functional and structural alterations of the anterior cingulate cortex (ACC) in OCD. In this study, we explored the functional activity of subregions of the ACC and effective connectivity (EC) between ACC subregions and the whole brain in OCD. We used a Granger causality analysis (GCA) to identify the direction of information flow and whether the impact of that flow was excitatory or inhibitory. We performed resting-state functional MRI in 31 patients with OCD and 36 healthy controls and analyzed the amplitude of low-frequency fluctuation (ALFF) and coefficient-based GCA. The left pregenual ACC (pACC) in patients with OCD showed decreased ALFF relative to controls. There was significantly decreased excitatory output from the left pACC to both right dorsal superior frontal gyrus (dSFG) and left precuneus in patients compared with controls. Patients also had decreased inhibitory input to left pACC from left ventral SFG and left thalamus and caudate relative to controls. Results were similar in drug-naive patients and those with prior but not current psychopharmacological treatment. In patients, path coefficients of GCA from left pACC to right dSFG showed significant negative correlations with obsession and anxiety ratings. Decreased spontaneous neural activity and altered EC of pACC with widely distributed cortical circuitry, and associations with clinical ratings highlight the importance of pACC functional alteration in OCD.

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Metabolic Imaging of Bilateral Anterior Capsulotomy in Refractory Obsessive Compulsive Disorder: an FDG PET Study

Cited by 50 publications

References 35 publications

Differences in Metabolic Network Modulation Between Capsulotomy and Deep-Brain Stimulation for Refractory Obsessive-Compulsive Disorder

Differences in Metabolic Network Modulation Between Capsulotomy and Deep-Brain Stimulation for Refractory Obsessive-Compulsive Disorder

Nuclear medicine in neuromodulation

Altered spontaneous activity and effective connectivity of the anterior cingulate cortex in obsessive–compulsive disorder

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