Mechanisms underlying capsulotomy for refractory obsessive-compulsive disorder: neural correlates of negative affect processing overlap with deep brain stimulation targets.
Mechanisms underlying capsulotomy for refractory obsessive-compulsive disorder: neural correlates of negative affect processing overlap with deep brain stimulation targets.
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DOI：
10.1038/s41380-023-01989-1
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发表时间：
2023-07
影响因子：
11
通讯作者：
Voon, Valerie
中科院分区：
文献类型：
--
作者：
Cui, Hailun;Zhang, Yingying;Zhao, Yijie;Zhao, Ying;Ding, Qiong;Chen, Ruiqin;Manssuer, Luis;Zhang, Chencheng;Liu, Wenjuan;Li, Dianyou;Sun, Bomin;Voon, Valerie
前囊切开术等消融手术对难治性强迫症(OCD)有潜在的疗效。越来越多的证据表明，腹侧内囊白质束横跨嘴扣带回、腹外侧额前皮质和丘脑是强迫症多个脑深部刺激靶点的最佳临床疗效靶点。在这里，我们通过使用任务功能磁共振成像和神经心理学测试来评估已知的与强迫症相关的认知机制，从而询问哪些前额叶区域和潜在的认知过程可能与囊膜切开术的效果有关。我们测试了强迫症患者(n = 27例)、强迫症对照组(n = 33例)和健康对照组(n = 34例)。我们使用了带有负面想象的修正的厌恶货币激励延迟范式和一项会话内消退试验。术后强迫症患者的强迫症症状、残疾和生活质量有所改善，但在执行、抑制、记忆和学习任务上的情绪或焦虑或认知任务表现方面没有差异。任务功能磁共振成像显示，截囊后，负预期时伏隔核减少，负反馈时左嘴扣带回和左下额叶皮质减少。囊膜切开术后患者的伏隔-嘴扣带回功能连接减弱。嘴扣带回活动介导的囊膜切开术对强迫症的改善。这些区域与强迫症多个刺激靶点观察到的最佳白质束重叠，可能为进一步优化神经调节方法提供见解。我们的发现还表明，厌恶加工的理论机制可能将消融、刺激和心理干预联系起来。
Ablative procedures such as anterior capsulotomy are potentially effective in refractory obsessive-compulsive disorder (OCD). Converging evidence suggests the ventral internal capsule white matter tracts traversing the rostral cingulate and ventrolateral prefrontal cortex and thalamus is the optimal target for clinical efficacy across multiple deep brain stimulation targets for OCD. Here we ask which prefrontal regions and underlying cognitive processes might be implicated in the effects of capsulotomy by using both task fMRI and neuropsychological tests assessing OCD-relevant cognitive mechanisms known to map across prefrontal regions connected to the tracts targeted in capsulotomy. We tested OCD patients at least 6 months post-capsulotomy (n = 27), OCD controls (n = 33) and healthy controls (n = 34). We used a modified aversive monetary incentive delay paradigm with negative imagery and a within session extinction trial. Post-capsulotomy OCD subjects showed improved OCD symptoms, disability and quality of life with no differences in mood or anxiety or cognitive task performance on executive, inhibition, memory and learning tasks. Task fMRI revealed post-capsulotomy decreases in the nucleus accumbens during negative anticipation, and in the left rostral cingulate and left inferior frontal cortex during negative feedback. Post-capsulotomy patients showed attenuated accumbens-rostral cingulate functional connectivity. Rostral cingulate activity mediated capsulotomy improvement on obsessions. These regions overlap with optimal white matter tracts observed across multiple stimulation targets for OCD and might provide insights into further optimizing neuromodulation approaches. Our findings also suggest that aversive processing theoretical mechanisms may link ablative, stimulation and psychological interventions.
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