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Metabolic Imaging of Anterior Capsular Stimulation in Refractory Obsessive-Compulsive Disorder: A Key Role for the Subgenual Anterior Cingulate and Ventral Striatum

¹ Division of Nuclear Medicine, University Hospital Gasthuisberg and Katholieke Universiteit Leuven, Leuven, Belgium; ² Department of Neurosurgery, University Hospital Gasthuisberg and Katholieke Universiteit Leuven, Leuven, Belgium; ³ Department of Psychiatry, University Hospital Antwerp, Antwerp, Belgium; and ⁴ Department of Psychiatry and Human Behavior, Butler Hospital, Providence, Rhode Island

Correspondence: For correspondence or reprints contact: Koen Van Laere, Division of Nuclear Medicine, University Hospital Gasthuisberg, Herestraat 39, 3000 Leuven, Belgium. E-mail: koen.vanlaere{at}uz.kuleuven.ac.be

High-frequency anterior capsular stimulation is a new, promising, and reversible neuromodulatory treatment in the research stage for patients with refractory obsessive-compulsive disorder (OCD). The mechanism of action is unknown but hypothesized to be secondary to interruption of the corticothalamostriatocortical circuit. Methods: ¹⁸F-FDG PET was performed on 6 consecutive OCD patients preoperatively and after stimulation. The results were compared with those of 20 age- and sex-matched healthy volunteers by using both a standardized volume-of-interest–based approach for subcortical areas and statistical parametric mapping. Correlations were investigated with Yale-Brown Obsessive Compulsive Scale scores (Y-BOCS) and Hamilton Depression Rating Scale scores (HAM-D). Results: Chronic anterior capsular electrostimulation resulted in a further decrease of prefrontal metabolic activity, especially in the subgenual anterior cingulate (P < 0.001). Correlation analysis demonstrated that decreases in Y-BOCS and HAM-D with anterior capsular electrostimulation were inversely related to the metabolic activity changes in the left ventral striatum, left amygdala, and left hippocampus (P < 0.01). Preoperative resting metabolic activity in the subgenual anterior cingulate was predictive of therapeutic response (P = 0.001). Conclusion: These observations provide evidence that the subgenual anterior cingulate and ventral striatum have a key role in the neuronal circuitry involved in the pathophysiology of OCD with associated major depression and in the neuromodulatory mechanism of anterior capsular stimulation.

Key Words: obsessive-compulsive disorder • capsular stimulation • PET • ¹⁸F-FDG • ventral striatum • anterior cingulate

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