Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder
Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder
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DOI：
10.1192/s0007125000297870
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发表时间：
1998-08
影响因子：
10.5
通讯作者：
S. Saxena;A. Brody;Jeffrey M. Schwartz;L. Baxter
中科院分区：
文献类型：
--
作者：
S. Saxena;A. Brody;Jeffrey M. Schwartz;L. Baxter
背景：神经影像学研究提供了强有力的证据表明，强迫症（OCD）的病理生理学涉及特定的额叶皮层下脑回路的功能异常。方法对强迫症患者的脑影像学研究进行文献检索。我们还回顾了有关皮质-基底神经节回路功能神经解剖学的基础科学文献，并将这些信息与强迫症的神经影像数据整合，以制定强迫症症状和治疗反应的大脑介导的理论模型。结果强迫症患者中至少有一个亚组存在基底节发育异常。功能性神经影像学研究表明，强迫症症状与眶额皮质、尾状核、丘脑和前扣带回的活动增加有关。结论强迫症症状是由眶额-皮层下神经回路的过度活跃所介导的，这可能是由于直接和间接纹状体-苍白球通路之间的张力失衡。我们提出了一个模型，它描述了如何额皮质下脑电路可能介导的强迫症神经病学，并提出了一个假设，如何成功的治疗可能会改善症状，通过其对电路活动的影响。
Background Neuroimaging studies provide strong evidence that the pathophysiology of obsessive-compulsive disorder (OCD) involves abnormal functioning along specific frontal-subcortical brain circuits. Method A literature search was carried out for all brain imaging studies of patients with OCD. We also reviewed the basic science literature on the functional neuroanatomy of cortico-basal ganglia circuits, and integrated this information with neuroimaging data in OCD to formulate a theoretical model of brain mediation of OCD symptoms and response to treatment. Results At least a subgroup of patients with OCD may have abnormal basal ganglia development. Functional neuroimaging studies indicate that OCD symptoms are associated with increased activity in orbitofrontal cortex, caudate nucleus, thalamus and anterior cingulate gyrus. Conclusions OCD symptoms are mediated by hyperactivity in orbitofrontal-subcortical circuits, perhaps due to an imbalance of tone between direct and indirect striatopallidal pathways. We present a model which describes how frontal-subcortical brain circuitry may mediate OCD symptomatology, and suggest a hypothesis for how successful treatments may ameliorate symptoms, via their effects on circuit activity.