Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study

Florence Le Jeune; Marc Vérin; Karim N'Diaye; Dominique Drapier; Emmanuelle Leray; Sophie Tezenas Du Montcel; Nicolas Baup; Antoine Pelissolo; Mircea Polosan; Luc Mallet; Jérome Yelnik; Bertrand Devaux; Denys Fontaine; Isabelle Chereau; Aurélie Bourguignon; Julie Peron; Paul Sauleau; Sylvie Raoul; Etienne Garin; Marie-Odile Krebs; Nematollah Jaafari; Bruno Millet; French Stimulation dans le trouble obsessionnel compulsif (STOC) study group

doi:10.1016/j.biopsych.2010.06.033

Decrease of prefrontal metabolism after subthalamic stimulation in obsessive-compulsive disorder: a positron emission tomography study

Biol Psychiatry. 2010 Dec 1;68(11):1016-22. doi: 10.1016/j.biopsych.2010.06.033. Epub 2010 Oct 16.

Collaborators

French Stimulation dans le trouble obsessionnel compulsif (STOC) study group:
L Mallet, Y Agid, B Aouizerate, C Arbus, T Bougerol, P Damier, D Fontaine, J L Houeto, M O Krebs, J J Lemaire, L Mallet, B Millet, P Pollak, D Hourton, S Aprelon, C Jourdain, E Bardinet, J Yelnik, P Burbaud, M L Welter, A H Clair, V Czernecki, M Vérin, S Tézenas du Montcel, D Madar, L Mallet, A Pelissolo, S Tezenas du Montcel, M L Welter, J Yelnik, L Mallet, A Pelissolo, Y Agid, P Cornu, S Navarro, M L Welter, A Hartmann, B Pidoux, D Grabli, V Czernecki, D Dormont, D Galanaud, J Yelnik, E Bardinet, C Béhar, Y Worbe, A H Clair, B Moutaud, B Aouizerate, P Burbaud, E Cuny, D Guehl, P M Llorca, I Chéreau, J J Lemaire, F Durif, P Derost, J Coste, J Gabrillargues, M Barget, I de Chazeron, T Bougerol, M Polosan, A L Benabid, S Chabardès, E Seigneuret, P Krack, P Pollak, C Ardouin, J F Le Bas, P Damier, Y Lajat, S Raoul, V Mattei, D Fontaine, M Borg, P Paquis, E Michel, P Robert, Marie-Noelle Magnié-Mauro, F Papetti, N Baup, B Devaux, M O Krebs, C Oppenheimer, J P Olié, D Ranoux, M Chayet, J L Houeto, N Jaafari, B Bataille, V Mesnage, R Gil, V Audouin, J L Senon, B Millet, M Vérin, D Drapier, P Sauleau, S Drapier, C Arbus, Y Lazorthe, P Chaynes, N Fabre, M Simonetta, L Schmitt, J A Lotterie, C Camassel, J C Aussilloux, S Blond, J Feingold, D Sicard, J Adès, J Cottraux, M Goudemand

Affiliation

¹ Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France. f.lejeune@rennes.fnclcc.fr

PMID: 20951978
DOI: 10.1016/j.biopsych.2010.06.033

Abstract

Background: High-frequency bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is a promising treatment in refractory obsessive-compulsive disorder (OCD).

Method: 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.

Conclusion: This study suggests that the therapeutic effect of STN DBS is related to a decrease in prefrontal cortex metabolism.

Trial registration: ClinicalTrials.gov NCT00169377.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain Mapping
Cross-Over Studies
Deep Brain Stimulation
Double-Blind Method
Female
Gyrus Cinguli / diagnostic imaging
Humans
Image Processing, Computer-Assisted
Male
Middle Aged
Obsessive-Compulsive Disorder / diagnostic imaging*
Obsessive-Compulsive Disorder / therapy*
Positron-Emission Tomography
Prefrontal Cortex / diagnostic imaging*
Severity of Illness Index
Statistics, Nonparametric
Subthalamic Nucleus / surgery*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00169377