Elsevier

Biological Psychiatry

Volume 68, Issue 11, 1 December 2010, Pages 1016-1022
Biological Psychiatry

Archival Report
Decrease of Prefrontal Metabolism After Subthalamic Stimulation in Obsessive-Compulsive Disorder: A Positron Emission Tomography Study

https://doi.org/10.1016/j.biopsych.2010.06.033Get rights and content

Background

High-frequency bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is a promising treatment in refractory obsessive-compulsive disorder (OCD).

Method

Using the crossover, randomized, and double-blind procedure adopted by the STOC study, 10 patients treated with high-frequency bilateral STN DBS underwent am 18-fluorodeoxyglucose positron emission tomography (PET) investigation to highlight the neural substratum of this therapeutic approach.

Results

The median Yale–Brown Obsessive Compulsive Scale (Y-BOCS) scores for all 10 patients were 31 (minimum = 18, maximum = 36) with “Off-Stimulation” status and 19 (minimum = 0, maximum = 30) with “On-Stimulation” status (p = .05). The OCD patients in Off-Stimulation status showed a hypermetabolism in the right frontal middle and superior gyri, right parietal lobe, postcentral gyrus, and bilateral putamen compared with healthy control subjects. A significant decrease in cerebral metabolism was observed in the left cingulate gyrus and the left frontal medial gyrus in On-Stimulation conditions compared with Off-Stimulation conditions. In addition, the improvement assessed by Y-BOCS scores during the On-Stimulation conditions was positively correlated with PET signal changes at the boundary of the orbitofrontal cortex and the medial prefrontal cortex, between PET signal changes and the Y-BOCS scores modifications in On-Stimulation status.

Conclusion

This study suggests that the therapeutic effect of STN DBS is related to a decrease in prefrontal cortex metabolism.

Section snippets

Participants

One group of patients with refractory OCD and one healthy control (HC) group took part in the study. The patient group comprised a series of 10 patients with refractory OCD, all of whom had undergone bilateral STN DBS in the STOC study. All the patients met the clinical DSM-IV criteria for OCD as a primary diagnosis. Standard selection and exclusion criteria for surgery of the patients have been described in detail in the clinical study (8). There were five men and five women. Mean (± SD) age

Clinical and Neuropsychological Effect of STN Stimulation

No significant differences were found between the On-Stimulation and Off-Stimulation conditions for the neuropsychologic background tests and the Montgomery–Åsberg Depression Scale score ranging from 0 to 60.

The median YBOCS scores for all 10 patients taken together were 31 (minimum = 18, maximum = 36) with Off-Stimulation status and 19 (minimum = 0, maximum = 30) with On-Stimulation status. The difference was statistically significant (p = .05). We found neither a carryover effect (p = .16)

Discussion

To our knowledge, this study is the first to describe the metabolic effects of STN DBS in refractory OCD patients. It is also the first to have used a double-blind randomized PET investigation to assess patients suffering from refractory OCD conducted within the framework of the STOC study. This study allowed us to investigate refractory OCD patients using functional neuroimaging. Whereas other techniques, such as functional MRI, require specific conditions for acquisitions in stimulated

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