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

Dazhi Yin; ChenCheng Zhang; Qiming Lv; Xiaoyu Chen; Kristina Zeljic; Hengfen Gong; Shikun Zhan; Haiyan Jin; Zheng Wang; Bomin Sun

doi:10.1016/j.biopsych.2018.04.006

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

Biol Psychiatry. 2018 Dec 15;84(12):926-936. doi: 10.1016/j.biopsych.2018.04.006. Epub 2018 Apr 22.

Authors

Dazhi Yin¹, ChenCheng Zhang², Qiming Lv³, Xiaoyu Chen³, Kristina Zeljic³, Hengfen Gong⁴, Shikun Zhan², Haiyan Jin⁵, Zheng Wang⁶, Bomin Sun⁷

Affiliations

¹ Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
² Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
³ Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China.
⁴ Department of Psychiatry, Pudong District Mental Health Center, Shanghai, China.
⁵ Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China. Electronic address: zheng.wang@ion.ac.cn.
⁷ Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. Electronic address: sbm11224@rjh.com.cn.

PMID: 29778276
DOI: 10.1016/j.biopsych.2018.04.006

Abstract

Background: Little is known about the neural mechanism and response variability underlying neurosurgical interventions for intractable obsessive-compulsive disorder (OCD).

Methods: Of 81 OCD patients screened for capsulotomy identified in our institutional database, 36 patients with clinical assessment before and after capsulotomy and imaging data (9 of 36 patients without postoperative imaging data used as an independent test group), and 29 healthy control subjects were retrospectively recruited. Twenty of 36 patients (56%) responded to the lesion procedure (determined as a ≥35% reduction in Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score). Seed-based (i.e., ventral and dorsal caudate, medial dorsal thalamus, and ventral and dorsal putamen) resting-state functional connectivity was used to examine alterations in frontostriatal circuitry after capsulotomy.

Results: The Y-BOCS score significantly decreased (p < .001) after capsulotomy in OCD patients. Functional connectivity between the ventral striatum/nucleus accumbens and the dorsal anterior cingulate cortex was reduced (p < .05, corrected) after the surgical procedure. Moreover, change in connectivity significantly correlated with alteration in Y-BOCS score (r = .41, p = .033). In addition, preoperative connectivity between the dorsal caudate and the dorsal anterior cingulate cortex could differentiate nonresponders from responders and predict changes in Y-BOCS score (R² = .23, F_1,25 = 7.56, p = .011), which was generalized in an independent test group.

Conclusions: We demonstrated that restoration of ventral frontostriatal connectivity was associated with clinical improvement in refractory OCD, suggesting a therapeutic mechanism of capsulotomy. Moreover, preoperative variations in dorsal frontostriatal connectivity predicted clinical response, which may offer a predictor of treatment outcome.

Keywords: Capsulotomy; Frontostriatal circuitry; Functional connectivity; Obsessive-compulsive disorder; Predictor; Therapeutic mechanism.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
China
Female
Gyrus Cinguli / physiopathology*
Humans
Magnetic Resonance Imaging
Male
Neurosurgical Procedures
Nucleus Accumbens / physiopathology*
Obsessive-Compulsive Disorder / diagnostic imaging
Obsessive-Compulsive Disorder / physiopathology*
Obsessive-Compulsive Disorder / surgery*
Retrospective Studies
Treatment Outcome
Young Adult