Dysfunctional Brain Circuits Overlap in Lesional and Idiopathic Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) may develop following brain lesions, but lesion distribution and connectivity patterns are unknown.

Cases of OCD associated with focal brain lesions were identified using a systematic literature search and compared with control lesions (n = 608). Connectivity with each lesion location was computed using normative functional connectivity (n = 1000), and a network specific to OCD lesions was identified. The relevance of this network for primary OCD was explored.

Among 129 cases of lesion-associated OCD, 40 had clearly defined locations. OCD-associated lesions intersected the orbitofrontal cortex and right temporal pole more than control lesions and were associated with connectivity to a distinct brain network. This network overlapped with abnormal functional brain imaging and with effective brain stimulation targets in primary OCD.

Lesion locations associated with OCD map to a common brain network that aligns with brain imaging abnormalities and brain stimulation outcomes in patients with primary OCD.