Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study.
BACKGROUND
High-frequency bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is a promising treatment in refractory obsessive-compulsive disorder (OCD).


METHODS
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.


CONCLUSIONS
This study suggests that the therapeutic effect of STN DBS is related to a decrease in prefrontal cortex metabolism.
Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France. f.lejeune@rennes.fnclcc.fr
Florence
F
Le Jeune
Marc
M
Vérin
Karim
K
N'Diaye
Dominique
D
Drapier
Emmanuelle
E
Leray
Sophie Tezenas
ST
Du Montcel
Nicolas
N
Baup
Antoine
A
Pelissolo
Mircea
M
Polosan
Luc
L
Mallet
Jérome
J
Yelnik
Bertrand
B
Devaux
Denys
D
Fontaine
Isabelle
I
Chereau
Aurélie
A
Bourguignon
Julie
J
Peron
Paul
P
Sauleau
Sylvie
S
Raoul
Etienne
E
Garin
Marie-Odile
MO
Krebs
Nematollah
N
Jaafari
Bruno
B
Millet
D000328:Adult; D001931:Brain Mapping; D018592:Cross-Over Studies; D046690:Deep Brain Stimulation; D004311:Double-Blind Method; D005260:Female; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging* / Q000628:therapy*; D049268:Positron-Emission Tomography; D017397:Prefrontal Cortex / Q000000981:diagnostic imaging*; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020531:Subthalamic Nucleus / Q000601:surgery*; D016896:Treatment Outcome