Brain white matter integrity and association with age at onset in pediatric obsessive-compulsive disorder

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 Pediatric Obsessive-Compulsive Disorder

Neuropsychopharmacology ◽

10.1038/npp.2012.138 ◽

2012 ◽

Vol 37 (12) ◽

pp. 2730-2739 ◽

Cited By ~ 44

Author(s):

Patricia Gruner ◽

An Vo ◽

Toshikazu Ikuta ◽

Katie Mahon ◽

Bart D Peters ◽

...

Keyword(s):

White Matter ◽

Obsessive Compulsive Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

White Matter Abnormalities

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Obsessive–compulsive disorder: subclassification based on co-morbidity

Psychological Medicine ◽

10.1017/s0033291708004753 ◽

2008 ◽

Vol 39 (9) ◽

pp. 1491-1501 ◽

Cited By ~ 60

Author(s):

G. Nestadt ◽

C. Z. Di ◽

M. A. Riddle ◽

M. A. Grados ◽

B. D. Greenberg ◽

...

Keyword(s):

Anxiety Disorder ◽

Obsessive Compulsive Disorder ◽

Clinical Characteristics ◽

Latent Class ◽

Age At Onset ◽

Separation Anxiety Disorder ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Co Morbidity ◽

The Relationship

BackgroundObsessive–compulsive disorder (OCD) is probably an etiologically heterogeneous condition. Many patients manifest other psychiatric syndromes. This study investigated the relationship between OCD and co-morbid conditions to identify subtypes.MethodSeven hundred and six individuals with OCD were assessed in the OCD Collaborative Genetics Study (OCGS). Multi-level latent class analysis was conducted based on the presence of eight co-morbid psychiatric conditions [generalized anxiety disorder (GAD), major depression, panic disorder (PD), separation anxiety disorder (SAD), tics, mania, somatization disorders (Som) and grooming disorders (GrD)]. The relationship of the derived classes to specific clinical characteristics was investigated.ResultsTwo and three classes of OCD syndromes emerge from the analyses. The two-class solution describes lesser and greater co-morbidity classes and the more descriptive three-class solution is characterized by: (1) an OCD simplex class, in which major depressive disorder (MDD) is the most frequent additional disorder; (2) an OCD co-morbid tic-related class, in which tics are prominent and affective syndromes are considerably rarer; and (3) an OCD co-morbid affective-related class in which PD and affective syndromes are highly represented. The OCD co-morbid tic-related class is predominantly male and characterized by high conscientiousness. The OCD co-morbid affective-related class is predominantly female, has a young age at onset, obsessive–compulsive personality disorder (OCPD) features, high scores on the ‘taboo’ factor of OCD symptoms, and low conscientiousness.ConclusionsOCD can be classified into three classes based on co-morbidity. Membership within a class is differentially associated with other clinical characteristics. These classes, if replicated, should have important implications for research and clinical endeavors.

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