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Research ArticleCLINICAL INVESTIGATIONS

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, Bart Nuttin, Loes Gabriels, Patrick Dupont, Steve Rasmussen, Benjamin D. Greenberg and Paul Cosyns
Journal of Nuclear Medicine May 2006, 47 (5) 740-747;
Koenraad Van Laere
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Bart Nuttin
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Loes Gabriels
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Patrick Dupont
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Steve Rasmussen
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Benjamin D. Greenberg
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Paul Cosyns
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  • 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.

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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.

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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.

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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.

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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.

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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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    TABLE 1

    Patient Profiles: Demographic Features and Clinical and Stimulation Characteristics

    Patient no.Age at ACaS (y)SexDisease duration (y)Stimulus parametersElectrode locationPreoperative scores
    MedicationStimulationY-BOCSHAM-DBDI
    134M23Lormetazepam (0.5 mg/d)Bilateral0−1−2−3+ACa384348
    252F28Sertraline (150 mg/d), prazepam (60 mg/d), diazepam (10 mg/d), trazodone (100 mg/d)Bilateral0+1−2+ACa332339
    338F22Fluoxetine (20 mg/d), clomipramine (50 mg/d), lorazepam (3.75 mg/d)Bilateral0−1−2−3−C+ACa302935
    440F26Fluoxetine (40 mg/d), thioridazine (50 mg/d), alprazolam (4 mg/d)Bilateral0+1−ACa + MD (not stimulated)341941
    538M21Clomipramine (225 mg/d), olanzapine (20 mg/d)Bilateral0−1+ACa302438
    640F19Clomipramine (75 mg/d)Right0−1+ACa351627
    • ACaS = anterior capsular stimulation; ACa = anterior limb of internal capsule; MD = mediodorsal thalamic nucleus.

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Journal of Nuclear Medicine: 47 (5)
Journal of Nuclear Medicine
Vol. 47, Issue 5
May 2006
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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, Bart Nuttin, Loes Gabriels, Patrick Dupont, Steve Rasmussen, Benjamin D. Greenberg, Paul Cosyns
Journal of Nuclear Medicine May 2006, 47 (5) 740-747;

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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, Bart Nuttin, Loes Gabriels, Patrick Dupont, Steve Rasmussen, Benjamin D. Greenberg, Paul Cosyns
Journal of Nuclear Medicine May 2006, 47 (5) 740-747;
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