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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

Koenraad Van Laere*,1, Bart Nuttin*,2, Loes Gabriels3, Patrick Dupont1, Steve Rasmussen4, Benjamin D. Greenberg4 and Paul Cosyns3

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


Figure 1
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  		FIGURE 1.  Inaccuracies in spatial normalization of homologous subcortical structures using 18F-FDG PET and SPM, version 2, with nonlinear warping (16 iterations) in 4 patients with OCD. Crossbars are centered on internal capsule between putamen and caudate head.

 

Figure 2
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  		FIGURE 2.  SPM glass brain representation of group metabolic characterization of refractory OCD patients with comorbid depressive symptoms. Large prefrontal cluster is seen extending to supplementary motor cortex. Image depicts peak threshold of 0.001 and extent threshold of 20 voxels.

 

Figure 3
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  		FIGURE 3.  Individual patient results for changes in clinical scores on chronic anterior capsular stimulation: Y-BOCS (A), HAM-D (B), and BDI (C). Horizontal lines are average values for groups. Preop = preoperative; Stim on = after chronic electrostimulation. *Overlapping data points.

 

Figure 4
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  		FIGURE 4.  SPM glass brain representation of paired-group comparison between preoperative resting-state metabolism and stimulator-on condition in 6 refractory OCD patients.

 

Figure 5
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  		FIGURE 5.  Correlation of ventral striatum metabolic activity with decrease in clinical Y-BOCS score. Circles and solid line are data for right side of brain; squares and dashed line are data for left side of brain. Decrease in score is score during stimulator-on condition minus score preoperatively.

 

Figure 6
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  		FIGURE 6.  (A) Inverse correlation between preoperative metabolism and changes in Y-BOCS scores shows that subgenual activity centered at MNI coordinates (8,30,–8) is related to outcome of clinical treatment. Images are overlaid on average T1-weighted volumetric MRI scan of patient group. (B) Metabolic response at (8,30,–8) versus decrease in Y-BOCS score. Values are centered around mean change in Y-BOCS score (–13.5).

 




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