A replication of cerebral metabolic correlates of OCD response to anterior cingulotomy

Abstract

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Objectives: In an effort to identify candidate imaging predictors of response, we previously studied 11 patients (7M:4F) undergoing anterior cingulotomy for OCD using positron emission tomography with fluorodeoxyglucose (PET-FDG). Using statistical parametric mapping methods, we found that pre-treatment regional cerebral metabolism at a locus within right posterior cingulate cortex (PCC) was significantly positively correlated with % improvement of Yale-Brown Obsessive Compulsive Scale (YBOCS) scores at ~6 months post-operative follow-up. In the current experiment, we sought to replicate the prior findings in an independent cohort of patients. Methods: Using PET-FDG methods, we studied 13 patients (10M:3F; mean ± SD age = 34.9 ±10 yrs.) undergoing anterior cingulotomy for severe, treatment-refractory OCD. Pre-treatment normalized regional brain metabolism was tested for correlation with % improvement in YBOCS score at follow-up, on a voxel-wise basis using SPM99 for statistical parametric mapping. A priori, we sought to replicate the previous results by searching for significant correlation within the right PCC. Results: In accord with prior results, we found a significant positive correlation between pre-surgical regional metabolism at a locus within right PCC and subsequent %YBOCS improvement at follow-up. Conclusions: Taken together, these findings suggest that pre-operative PET-FDG may be used to measure right PCC regional metabolism as an index to predict subsequent response to anterior cingulotomy for OCD. It is hoped that refinements of this application may help identify and exclude candidates who are unlikely to derive benefits from the operation, thereby functionally enhancing effectiveness rates of anterior cingulotomy for OCD, as well as its risk/cost-benefit profile.

Research Support (if any): None