Dissociable Frontostriatal Connectivity: Mechanism and Predictor of the Clinical Efficacy of Capsulotomy in Obsessive-Compulsive Disorder

Yin, Dazhi; Zhang, Chencheng; Lv, Qiming; Chen, Xiaoyu; Zeljic, Kristina; Gong, Hengfen; Zhan, Siyan; Jin, Haiyan; Wang, Zheng; Sun, Bomin

doi:10.1016/j.biopsych.2018.04.006

Cited by 46 publications

(37 citation statements)

References 60 publications

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“…Overall, activation abnormalities within cingulo-opercular and orbito-striato-thalamic regions are consistent with previous findings of alterations in these regions at rest (53,65,66) The current results are also interesting when considering that existing neurosurgical treatments for severe refractory OCD target cingulo-opercular and orbito-striato-thalamic networks (76)(77)(78). For instance, dorsal anterior cingulotomy involves making small stereotactic lesions to a region of pMFC similar to the one found to be hyperactive to errors in the current metaanalysis, and treatment response following this surgery is predicted by pMFC gray matter volume and pMFC-striatal structural connectivity (77).…”

Section: Discussionsupporting

confidence: 90%

“…These post-error adjustments include behavioral adjustments such as correcting the original incorrect response, recalibrating speedaccuracy tradeoffs (e.g., post-error slowing), and enhancing task-focused attention and interference resolution, as well as neural adaptations including the up-regulation of taskrelevant brain activation on subsequent trials (9,14,82,83). However, patients with OCD typically show either no performance differences relative to controls or poorer performance and impaired post-error adjustments (77,78), perhaps suggesting that the mechanism linking cingulo-opercular activation during errors and subsequent corrective recruitment of inhibitory control brain networks may be inefficient in OCD, or else suggesting that cingulo-opercular hyperactivation to errors during error-processing is unable to correct pre-existing deficits in inhibitory control related brain activation in the disorder.…”

Section: Discussionmentioning

confidence: 99%

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Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps

Norman

Taylor

Liu

et al. 2019

Biological Psychiatry

141

107

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps

Norman

Taylor

Liu

et al. 2019

Biological Psychiatry

141

107

View full text Add to dashboard Cite

show abstract

“…Dysfunctional connectivity patterns within this network have been implicated in the pathogenesis of many psychiatric illnesses, including OCD and MDD 17,18 . Lesioning the ALIC is intended to disrupt the aberrant activity within this network, and mitigate clinical symptoms 19 .…”

Section: Introductionmentioning

confidence: 99%

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

et al. 2020

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Magnetic resonance-guided focused ultrasound (MRgFUS) anterior capsulotomy is a novel treatment option for patients with refractory obsessive compulsive disorder (OCD) or major depressive disorder (MDD). However, there is concern that lesional psychiatric surgery procedures may have adverse effects on cognition. In this study, we examined whether MRgFUS capsulotomy causes cognitive decline in patients with psychiatric illness. Ten patients with refractory OCD (n = 5) or MDD (n = 5) underwent MRgFUS capsulotomy. Cognitive functioning was measured at baseline as well as 6 months and 12 months postoperatively, with a battery of neuropsychological tests assessing domains of executive function, memory, and processing speed. Scores were analyzed at the individual-level, and changes ≥2 standard deviations were considered clinically significant. We also examined whether changes in clinical symptoms were associated with changes in cognitive performance. At baseline intellectual functioning was in the average to high-average range for the group. Following MRgFUS capsulotomy, there were no deteriorations in cognition that reached ≥2 standard deviations at 6 or 12 months. Eight out of ten patients demonstrated a ≥2 standard deviation improvement in at least one cognitive score at 6 or 12 months postoperatively. Improvements in clinical symptoms correlated significantly with self-reported improvements in frontal lobe function (p < 0.05), but not with objective measures of cognitive functioning. To summarize, MRgFUS capsulotomy did not result in cognitive decline in this cohort of patients with refractory OCD or MDD, suggesting that this procedure can be offered to patients with a very low risk of cognitive side effects.

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“…Similarly, his OCD symptoms had failed to respond to multiple trials of pharmacotherapy of adequate duration and dose, including augmenting medications ( Table 1). In 2012, the patient underwent bilateral anterior capsulotomy, but this neurosurgical intervention had limited therapeutic effects; the patient selection criteria used for this surgical intervention has been described elsewhere (8). In 2014, the patients received bilateral cingulotomy, which was also mostly ineffective.…”

Section: Case Presentationmentioning

confidence: 99%

Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report

Zhang

et al. 2020

Front. Psychiatry

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Background: Some patients suffer from persistent and severely disabling Obsessive-Compulsive Disorder (OCD) symptoms that cannot be alleviated by conventional treatments or neuroablative interventions targeting cortico-striatal loop circuits. Currently, it is unclear how to manage the clinical symptoms of these unique patients. We reasoned that deep brain stimulation (DBS) of the habenula (HB) could be a valuable subsequent treatment option for these otherwise medically intractable cases of severe OCD. The HB is an epithalamic structure critically involved in the encoding and responding to aversive stimulus events, cognitive and brain processes known to be impaired in many patients with OCD. Similarly, HB DBS can alleviate depression and anxiety, which often co-occur with OCD. Here, we explore the clinical benefits and risks of HB DBS treatment in a patient with severe and refractory OCD.Case Presentation: A 30-year-old male patient presented with persistent and severely disabling OCD symptoms that were refractory to previous psychological and pharmacological treatments as well as to neuroablative surgical interventions involving both capsulotomy and cingulotomy. After HB DBS, however, the severity of the patient's OCD symptoms was markedly reduced at 1-month follow-up, which was sustained until the final (at 12-month) follow-up. The patient also reported enduring improvements in depression, anxiety, and health-related quality of life after several months of HB DBS treatment. Conclusions:This case report provides the first clinical evidence suggesting that HB DBS could serve as a safe and effective alternative neurosurgical intervention for severe and refractory OCD. The present findings are promising and warrant further research into the role of the HB in pathophysiology and treatment of OCD.

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Dissociable Frontostriatal Connectivity: Mechanism and Predictor of the Clinical Efficacy of Capsulotomy in Obsessive-Compulsive Disorder

Cited by 46 publications

References 60 publications

Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps

Error Processing and Inhibitory Control in Obsessive-Compulsive Disorder: A Meta-analysis Using Statistical Parametric Maps

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

Habenular Stimulation for Neurosurgery Resistant Obsessive-Compulsive Disorder: A Case Report

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