Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive compulsive disorder.
BACKGROUND
As interventions for severe, treatment-refractory obsessive compulsive disorder (OCD), neurosurgical procedures are associated with only modest efficacy. The purpose of this study was to identify cerebral metabolic correlates as potential predictors of treatment response to anterior cingulotomy for OCD.


METHODS
Clinical data were analyzed in the context of a retrospective design. Subjects were 11 patients who underwent stereotactic anterior cingulotomy for OCD. Symptom severity was measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) before and at approximately 6 months postoperative. Preoperative F-18-fluorodeoxyglucose-positron emission tomography (FDG-PET) data were available. Statistical parametric mapping methods were used to identify loci of significant correlation between preoperative regional cerebral metabolism and postoperative reduction in Y-BOCS scores.


RESULTS
One locus within right posterior cingulate cortex was identified, where preoperative metabolism was significantly correlated with improvement in OCD symptom severity following cingulotomy. Specifically, higher preoperative rates of metabolism at that locus were associated with better postoperative outcome.


CONCLUSIONS
A possible predictor of treatment response was identified for patients with OCD undergoing anterior cingulotomy. Further research, utilizing a prospective design, is indicated to determine the validity and reliability of this finding. If confirmed, an index for noninvasively predicting response to cingulotomy for OCD would be of great value.
Rauch
S L
SL
Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Dougherty
D D
DD
Cosgrove
G R
GR
Cassem
E H
EH
Alpert
N M
NM
Price
B H
BH
Nierenberg
A A
AA
Mayberg
H S
HS
Baer
L
L
Jenike
M A
MA
Fischman
A J
AJ
D000328:Adult; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006179:Gyrus Cinguli / Q000033:anatomy & histology / Q000378:metabolism* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000601:surgery*; D011184:Postoperative Period; D011300:Preoperative Care; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013238:Stereotaxic Techniques; D011795:Surveys and Questionnaires; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18