J Korean Med Sci.  2011 May;26(5):665-674. 10.3346/jkms.2011.26.5.665.

Altered Brain Activation in Ventral Frontal-Striatal Regions Following a 16-week Pharmacotherapy in Unmedicated Obsessive-Compulsive Disorder

• Han JY
• Kang DH
• Gu BM
• Jung WH
• Choi JS
• Choi CH
• Jang JH
• Kwon JS

• KMID: 1777867
• DOI: http://doi.org/10.3346/jkms.2011.26.5.665

Abstract

Recent studies have reported that cognitive inflexibility associated with impairments in a frontal-striatal circuit and parietal region is a core cognitive deficit of obsessive-compulsive disorder (OCD). However, few studies have examined progressive changes in these regions following clinical improvement in obsessive-compulsive symptoms. To determine if treatment changes the aberrant activation pattern associated with task switching in OCD, we examined the activation patterns in brain areas after treatment. The study was conducted on 10 unmedicated OCD patients and 20 matched controls using event-related functional magnetic resonance imaging. Treatment improved the clinical symptoms measured by the Yale-Brown Obsessive Compulsive Scale and behavioral flexibility indicated by the switching cost. At baseline, OCD showed significantly less activation in the dorsal and ventral frontal-striatal circuit and parietal regions under the task-switch minus task-repeat condition compared with controls. After treatment, the neural responses in the ventral frontal-striatal circuit in OCD were partially normalized, whereas the activation deficit in dorsal frontoparietal regions that mediate shifting attention or behavioral flexibility persisted. It is suggested that altered brain activation in ventral frontal-striatal regions in OCD patients is associated with their cognitive flexibility and changes in these regions may underlie the pathophysiology of OCD.

Keyword

Task-Switching; Cognitive Flexibility; Obsessive-Compulsive Disorder; Drug Therapy; Ventral Frontal-Striatal Region

MeSH Terms

Adult
Basal Ganglia/*metabolism
Behavioral Symptoms/drug therapy
Female
Frontal Lobe/*drug effects/physiopathology
Humans
Magnetic Resonance Imaging
Male
Obsessive-Compulsive Disorder/*drug therapy/physiopathology
Parietal Lobe/*drug effects/physiopathology

Figure

• 

  Fig. 1 Decreased activation in OCD patients before and after treatment compared to the controls (for illustrative purpose, P < 0.005 uncorrected, cluster level > 30). Activation in ventral frontal regions in OCD was normalized after treatment. However, dysfunctional activation in dorsal frontal regions persisted regardless of treatment.

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  Fig. 2 The different activations between OCD patients at baseline and controls and between pre- and post-treatment in patients. (A) Dysfunctional activation pattern was sustained in the dorsal frontoparietal regions, indicated by the blue line circle, while the ventral frontal, striatal and limbic/paralimbic regions, indicated by the red line circle, were partially normalized after treatment. (B) Mean percent signal change for task-switch minus task-repeat of the controls, pre-treatment and post-treatment OCD patients in the ROIs. The significant differences in regional activity between pre- and post-treatment in OCD patients are presented in *P < 0.05, using LSD post hoc test. DLPFC, dorsolateral prefrontal cortex; VLPFC, ventrolateral prefrontal cortex; rACC, rostral anterior cingulate cortex; OFC, orbitofrontal cortex; Hipp, Hippocampus.

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  Fig. 3 The correlation of percent (%) Y-BOCS improvement and longitudinal change in left thalamus activation. The correlation coefficient was -0.82 (< 0.006; corrected P value = 0.05/9).

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  Fig. 4 Activation maps showing the results of fixed effects analyses in patients before and after treatment separately. Although fixed effects results cannot be generalized beyond the samples studies, these results are presented to emphasize the similarities and the differences in task-switching-related brain regions in patients with OCD before and after treatment. Both patients before and after treatment showed the similar activation patterns in the DLPFC and parietal cortex, while different activation patterns in the OFC, ACC, and caudate were observed. (A) Surface rendering of fixed effects results. (B) Multislice coronal view of fixed effects results.

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