TY - JOUR T1 - Metabolic Imaging of Anterior Capsular Stimulation in Refractory Obsessive-Compulsive Disorder: A Key Role for the Subgenual Anterior Cingulate and Ventral Striatum JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 740 LP - 747 VL - 47 IS - 5 AU - Koenraad Van Laere AU - Bart Nuttin AU - Loes Gabriels AU - Patrick Dupont AU - Steve Rasmussen AU - Benjamin D. Greenberg AU - Paul Cosyns Y1 - 2006/05/01 UR - http://jnm.snmjournals.org/content/47/5/740.abstract N2 - 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. ER -