Ho Pian Kamini L, van Megen Harold J G M, Ramsey Nick F, Mandl René, van Rijk Peter P, Wynne H J, Westenberg Herman G M
Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
Psychiatry Res. 2005 Feb 28;138(2):89-97. doi: 10.1016/j.pscychresns.2004.12.003.
Functional imaging studies have pointed to a role of the orbitofrontal cortex (OFC), striatum and thalamus in the pathophysiology of obsessive-compulsive disorder (OCD). Effective treatment has been found to change brain activity within this circuitry. The aim of the present study was to explore possible differential effects of OCD responders and non-responders to drug treatment on the regional cerebral blood flow (rCBF). Measurements of rCBF were carried out in 15 out of 22 patients with OCD who completed an open-label trial with fluvoxamine. Patients were studied with 99mTc-HMPAO single photon emission computed tomography (SPECT) before and after 12 weeks of treatment. In addition, structural magnetic resonance imaging was obtained on all patients. Regions of interest comprised the OFC, caudate nucleus, putamen and thalamus. Seven patients responded to treatment. Levels of rCBF decreased significantly in the left caudate nucleus and the left and right putamen in both responders and non-responders to treatment. In responders, but not in non-responders, a significant decrease in rCBF was found in the right thalamus. Pre-treatment cerebellar and whole brain HMPAO uptake was significantly higher in responders to treatment compared with non-responders. We suggest that the thalamus plays a central role in the response to drug treatment.
功能成像研究表明，眶额皮质（OFC）、纹状体和丘脑在强迫症（OCD）的病理生理学中发挥作用。已发现有效治疗可改变该神经回路内的脑活动。本研究的目的是探讨强迫症患者对药物治疗的反应者和无反应者对局部脑血流（rCBF）可能产生的不同影响。对22例完成氟伏沙明开放标签试验的强迫症患者中的15例进行了rCBF测量。在治疗12周前后，对患者进行了99mTc-HMPAO单光子发射计算机断层扫描（SPECT）检查。此外，对所有患者进行了结构磁共振成像检查。感兴趣区域包括眶额皮质、尾状核、壳核和丘脑。7例患者对治疗有反应。治疗反应者和无反应者的左侧尾状核以及左侧和右侧壳核的rCBF水平均显著下降。在治疗反应者中，右侧丘脑的rCBF显著下降，而无反应者则未出现这种情况。治疗反应者治疗前小脑和全脑HMPAO摄取量显著高于无反应者。我们认为，丘脑在药物治疗反应中起核心作用。
