Predictors of treatment response to fluvoxamine in obsessive-compulsive disorder: an fMRI study.
Recent neuroimaging studies suggest that the pathophysiology of obsessive-compulsive disorder (OCD) may involve more widely distributed large-scale brain systems, including the parietal, occipital, and cerebellar areas, rather than the conventional orbitofronto-striatal model. We hypothesized that not only orbitofrontal cortex and caudate nucleus activities but also posterior brain regions might be associated with subsequent treatment response to serotonin reuptake inhibitors in OCD. The participants were 17 patients with OCD. Each patient was required to undergo fluvoxamine pharmacotherapy for 12 weeks. Before treatment, fMRI images of the subjects were obtained in the context of a symptom-provocation paradigm. The percentage changes in total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, from pre- to post-treatment, served as the index of treatment response. Statistical Parametric Mapping was used to identify brain loci where pre-treatment brain activation significantly correlated with the subsequent treatment response. Fifteen of 17 patients completed the 12-week treatment. During the symptom provocation task, patients showed brain activation in the left superior temporal gyrus (STG), left precuneus, left frontal cortices, right cerebellum, and right frontal cortices. We found that pre-treatment activation in the right cerebellum (Z-score=5.10, x,y,z=22,-84,-18) and the left STG (Z-score=4.95, x,y,z=-62,-22,0) was positively correlated with the improvement in the Y-BOCS score. Our results suggest that pre-treatment activation in the right cerebellum and in the left STG predict subsequent reduction in OCD symptom severity. There is every possibility that fMRI can be used as a tool to predict treatment response.
Sanematsu
Hirokuni
H
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Nakao
Tomohiro
T
Yoshiura
Takashi
T
Nabeyama
Maiko
M
Togao
Osamu
O
Tomita
Mayumi
M
Masuda
Yusuke
Y
Nakatani
Eriko
E
Nakagawa
Akiko
A
Kanba
Shigenobu
S
D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000187:drug effects* / Q000473:pathology; D001931:Brain Mapping; D005260:Female; D016666:Fluvoxamine / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008279:Magnetic Resonance Imaging; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000473:pathology*; D010100:Oxygen / Q000097:blood; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
D016666:Fluvoxamine; D010100:Oxygen; D017367:Selective Serotonin Reuptake Inhibitors