Cerebral activation in children and adolescents with obsessive-compulsive disorder before and after treatment: a functional MRI study.
BACKGROUND
Structural and functional fronto-striatal abnormalities are involved in the pathophysiology of obsessive-compulsive disorder (OCD). The aims of the present study were: (a) to investigate possible regional brain dysfunction in premotor cortico-striatal activity in drug-naïve children and adolescents with OCD; (b) to correlate brain activation with severity of obsessive-compulsive symptomatology; and (c) to detect possible changes in brain activity after pharmacological treatment.


METHODS
Twelve children and adolescents (age range 7-18 years; seven male, five female) with DSM-IV obsessive-compulsive disorder and twelve healthy subjects matched for age, sex and intellectual level were studied. Functional magnetic resonance imaging data were obtained during the performance of simple and complex sequences.


RESULTS
Comparing the complex motor condition with the simple control condition, both patients and controls showed a pattern of cerebral activation involving the fronto-parietal cortex and basal ganglia. Compared with controls, OCD patients presented significantly higher brain activation bilaterally in the middle frontal gyrus. After 6 months of pharmacological treatment and with clear clinical improvement, activation in the left insula and left putamen decreased significantly.


CONCLUSIONS
In a paediatric OCD sample that was treatment naïve and without another psychiatric disorder we showed hyperactivation of the circuits that mediate symptomatic expression of OCD. The cerebral activation decreases after treatment and clinical improvement.
Lázaro
Luisa
L
Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari of Barcelona, Spain. llazaro@clinic.ub.es
Caldú
Xavier
X
Junqué
Carme
C
Bargalló
Núria
N
Andrés
Susana
S
Morer
Astrid
A
Castro-Fornieles
Josefina
J
D000293:Adolescent; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001479:Basal Ganglia / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology; D001931:Brain Mapping; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000098:blood supply* / Q000187:drug effects / Q000503:physiopathology*; D002648:Child; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000473:pathology* / Q000503:physiopathology*; D010100:Oxygen / Q000097:blood; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000187:drug effects / Q000502:physiology; D011930:Reaction Time / Q000187:drug effects / Q000502:physiology
D014150:Antipsychotic Agents; D010100:Oxygen