Obsessive-compulsive symptoms and inflammatory brain changes detected using an innovative multimodal diagnostic...

Area of Science:

• Neuroscience
• Immunology
• Radiology

Background:

• Obsessive-compulsive disorder (OCD) involves dysfunction in brain circuits and neurotransmitter systems.
• Autoimmune processes can rarely cause OCD, presenting diagnostic challenges.
• Multimodal diagnostics can reveal subtle neuroinflammation in clinical cases.

Purpose of the Study:

• To illustrate the utility of advanced multimodal diagnostics in identifying an autoimmune cause of OCD.
• To investigate the pathophysiological underpinnings of OCD with neuroinflammation and frontal disconnection.
• To demonstrate the impact of targeted treatment on clinical symptoms and neuroimaging findings.

Main Methods:

• Susceptibility-weighted magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to assess brain microstructure and microbleeds.
• Diffusion microstructure imaging (DMI) compared between patient and healthy controls.
• [¹⁸F]fluorodeoxyglucose-positron emission tomography (FDG-PET) for metabolic assessment.
• Electroencephalography (EEG) for electrophysiological evaluation.
• Cerebrospinal fluid (CSF) analysis for autoantibodies against nuclear antigens (ANAs).

Main Results:

• MRI revealed a left thalamic microbleed involving fronto-thalamic fibers.
• DMI showed widespread cerebral microstructure alterations, including edema and cortical changes.
• CSF analysis detected immunoglobulin G autoantibodies against nuclear antigens (ANAs).
• Treatment resulted in significant clinical improvement and reduced DMI alterations.

Conclusions:

• Advanced multimodal diagnostics can elucidate pathophysiological mechanisms in OCD, including autoimmune contributions.
• Detection of intrathecal ANAs supports an autoimmune etiology for OCD with neuroinflammation.
• Precision medicine approaches, guided by deep clinical phenotyping, are crucial for OCD management.