Differences in metabolic network modulation between capsulotomy and deep-brain stimulation for refractory...

Area of Science:

• Neuroscience
• Neurosurgery
• Psychiatry

Background:

• Obsessive-compulsive disorder (OCD) affects 7%-10% of patients refractory to standard treatments.
• Neurosurgical options include capsulotomy and deep-brain stimulation (DBS).
• The corticostriatopallidothalamocortical (CSPTC) circuit's role in OCD is established, but intervention mechanisms remain unclear.

Purpose of the Study:

• To compare the network modulation effects of capsulotomy and DBS in OCD patients.
• To investigate the relationship between metabolic changes and clinical improvement.

Main Methods:

• 13 capsulotomy and 16 DBS patients underwent (18)F-FDG PET scans pre- and post-intervention.
• Metabolic changes were analyzed using SPM8 and compared between groups and with healthy volunteers.
• Correlations with Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D) scores were examined.

Main Results:

• Both capsulotomy and DBS showed postoperative metabolic decreases in the anterior cingulate and orbitofrontal cortices.
• Capsulotomy induced more pronounced metabolic changes, including in the mediodorsal thalamus and caudate nucleus.
• Observed metabolic changes in the occipital cortex correlated with Y-BOCS score improvement.

Conclusions:

• Capsulotomy and DBS yield comparable clinical improvements and CSPTC circuit modulation in OCD.
• Capsulotomy demonstrates more extensive metabolic alterations than DBS.
• Non-CSPTC cortical regions may also contribute to OCD symptomatology.