P.1.e.033 White matter diffusivity changes in obsessive-compulsive disorder: a diffusion tensor MRI study with Tract-Based Spatial Statistics

Objective: Deep brain stimulation (DBS) was proposed in 1999 to treat refractory obsessive-compulsive disorder (OCD). Despite the accumulated experience over more than two decades, 30–40% of patients fail to respond to this procedure. One potential reason to explain why some patients do not improve in the postoperative period is that DBS might not have engaged structural therapeutic networks that are crucial to a favorable outcome in non-responders. This article reviews magnetic resonance imaging diffusion studies (DTI-MRI), analyzing neural networks likely modulated by DBS in OCD patients and their corresponding clinical outcome.Methods: We used a systematic review process to search for studies published from 2005 to 2020 in six electronic databases. Search terms included obsessive-compulsive disorder, deep brain stimulation, diffusion-weighted imaging, diffusion tensor imaging, diffusion tractography, tractography, connectome, diffusion analyses, and white matter. No restriction was made concerning the surgical target, DTI-MRI technique and the method of data processing.Results: Eight studies published in the last 15 years were fully assessed. Most of them used 3 Tesla DTI-MRI, and different methods of data acquisition and processing. There was no consensus on potential structures and networks underlying DBS effects. Most studies stimulated the ventral anterior limb of the internal capsule (ALIC)/nucleus accumbens. However, the contribution of different white matter pathways that run through the ALIC for the effects of DBS remains elusive. Moreover, the improvement of cognitive and affective symptoms in OCD patients probably relies on electric modulation of distinct networks.Conclusion: Though, tractography is a valuable tool to understand neural circuits, the effects of modulating different fiber tracts in OCD are still unclear. Future advances on image acquisition and data processing and a larger number of studies are still required for the understanding of the role of tractography-based targeting and to clarify the importance of different tracts for the mechanisms of DBS.

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White matter abnormalities in obsessive-compulsive disorder: A diffusion tensor imaging study

European Psychiatry ◽

10.1016/j.eurpsy.2008.01.1221 ◽

2008 ◽

Vol 23 ◽

pp. S353 ◽

Cited By ~ 1

Author(s):

Y. Saito ◽

K. Nobuhara ◽

G. Okugawa ◽

K. Takase ◽

A. Tajika ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Obsessive Compulsive Disorder ◽

Diffusion Tensor ◽

Imaging Study ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

White Matter Abnormalities ◽

Diffusion Tensor Imaging Study

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WHITE MATTER ABNORMALITIES IN CHILDREN AND ADOLESCENTS WITH OBSESSIVE-COMPULSIVE DISORDER: A DIFFUSION TENSOR IMAGING STUDY

Depression and Anxiety ◽

10.1002/da.21890 ◽

2012 ◽

Vol 29 (9) ◽

pp. 780-788 ◽

Cited By ~ 39

Author(s):

Rajan Nishanth Jayarajan ◽

Ganesan Venkatasubramanian ◽

Biju Viswanath ◽

Y.C. Janardhan Reddy ◽

Shoba Srinath ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

White Matter ◽

Children And Adolescents ◽

Obsessive Compulsive Disorder ◽

Diffusion Tensor ◽

Imaging Study ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

White Matter Abnormalities ◽

Diffusion Tensor Imaging Study

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White Matter Microstructure and its Relation to Clinical Features of Obsessive-Compulsive Disorder: Findings from the ENIGMA OCD Working Group

10.1101/855916 ◽

2019 ◽

Cited By ~ 4

Author(s):

Fabrizio Piras ◽

Federica Piras ◽

Yoshinari Abe ◽

Sri Mahavir Agarwal ◽

Alan Anticevic ◽

...

Keyword(s):

White Matter ◽

Obsessive Compulsive Disorder ◽

Clinical Features ◽

Pediatric Patients ◽

Diffusion Tensor ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Microstructural Alterations ◽

Pediatric Ocd ◽

Medication Status

ABSTRACTImportanceMicrostructural alterations in cortico-subcortical connections are thought to be present in Obsessive-Compulsive Disorder (OCD). However, prior studies have yielded inconsistent findings, perhaps because small sample sizes provided insufficient power to detect subtle abnormalities.ObjectiveTo investigate microstructural white matter alterations and their relation to clinical features in the largest dataset of adult and pediatric OCD to date.Design, Setting, and ParticipantsIn this cross-sectional case-control magnetic resonance study, we investigated diffusion tensor imaging metrics from 700 adult patients and 645 adult controls, as well as 174 pediatric patients and 144 pediatric controls across 19 sites participating in the ENIGMA-OCD Working Group.Main Outcomes and MeasuresWe extracted measures of fractional anisotropy (FA) as main outcome, and mean diffusivity, radial diffusivity, and axial diffusivity as secondary outcomes for 25 white matter regions. We meta-analyzed patient-control group differences (Cohen’s d) across sites, after adjusting for age and sex, and investigated associations with clinical characteristics.ResultsAdult OCD patients showed significant FA reduction in the sagittal stratum (d=-0.21, z=-3.21, p=0.001) and posterior thalamic radiation (d=-0.26, z=-4.57, p<0.0001). In the sagittal stratum only, lower FA was associated with a younger age of onset (z=2.71, p=0.006), longer duration of illness (z=-2.086, p=0.036) and a higher percentage of medicated patients in the cohorts studied (z=-1.98, p=0.047). No significant association with symptom severity was found. Pediatric OCD patients did not show any detectable microstructural abnormalities compared to matched controls.Conclusions and RelevanceMicrostructural alterations in projection and association fibers to posterior brain regions were found in adult OCD, and related to disease course and medication status. Such results are relevant to models positing deficits in connectivity as a crucial mechanism in OCD.KEY POINTSQuestionDo patients with Obsessive-Compulsive Disorder (OCD) show white matter microstructural alterations, and are these alterations related to clinical features?FindingsData from 19 sites of the ENIGMA-OCD Consortium were included, involving 700 adult patients and 645 adult controls, 174 pediatric patients and 144 pediatric controls. Diffusion tensor imaging data were meta-analyzed using a harmonized data processing and analysis protocol. Adult, but not pediatric, patients showed alterations in the sagittal stratum and posterior thalamic radiation; sagittal stratum differences were associated with clinical features.MeaningMicrostructural abnormalities found in adult but not in the pediatric cohort, are related to illness duration and medication status.

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Diffusion Tensor Imaging Before and 3 Months After Concentrated Exposure Response Prevention in Obsessive-Compulsive Disorder

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.674020 ◽

2021 ◽

Vol 12 ◽

Author(s):

Vilde Brecke ◽

Anders Lillevik Thorsen ◽

Olga Therese Ousdal ◽

Chris Vriend ◽

Dag Alnæs ◽

...

Keyword(s):

Treatment Outcome ◽

Diffusion Tensor Imaging ◽

White Matter ◽

Obsessive Compulsive Disorder ◽

Diffusion Tensor ◽

Healthy Controls ◽

Obsessive Compulsive ◽

Illness Onset ◽

Compulsive Disorder ◽

White Matter Microstructure

Background: Subtle differences in white matter microstructure have been found in obsessive-compulsive disorder (OCD) compared to controls using diffusion tensor imaging (DTI), but it is unclear if and how this change after treatment. The primary aim of this pre-registered study was to investigate white matter integrity between OCD patients and controls and changes after concentrated exposure and response prevention (ERP).Methods: Fractional anisotropy (FA), radial diffusivity (RD), axial diffusivity (AD) and mean diffusivity (MD) were estimated using FMRIB Software Library (FSL). The images were registered to a study-specific template using a longitudinal pipeline based on full tensor information in DTI-TK. Voxel-based analysis was performed using tract-based spatial statistics (TBSS). Using SPSS, we compared the integrity in three bilateral regions of interest (ROI), the sagittal stratum, posterior thalamic radiation and cingulum, in 32 OCD patients and 30 matched healthy controls at baseline. Patients received a four-day concentrated ERP format. We investigated longitudinal changes in 26 OCD patients and 22 healthy controls at 3months follow-up using repeated-measures ANOVA. Exploratory t-tests were conducted for AD and MD. Secondary hypothesis used linear regression to investigate if baseline FA predict treatment outcome 3 months later, and if patients with illness onset before 18 years of age would show lower FA in sagittal stratum. Finally, we performed sensitivity analysis on medication and comorbidity influences on FA.Results: Three months after treatment, 77% of the patients were in remission. Contrary to our hypotheses, we did not find any significant differences in FA, RD, AD or MD between the groups before treatment, nor significant group by time effects in any of the ROI. None of the baseline FA measures significantly predicted treatment outcome. Illness onset before 18 years of age did not significantly predict FA in the sagittal stratum. Adjusting for medication or comorbid anxiety or mood disorder did not influence the results.Conclusions: Although concentrated ERP in OCD lead to high remission, we did not find significant long-term changes by DTI. Future studies will benefit from using larger sample sizes and multi-shell diffusion-weighted imaging when investigating white matter microstructure in OCD and underlying neurobiological mechanisms of treatment.

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