University of Michigan Medical School, MI, USA.
J Am Acad Child Adolesc Psychiatry. 2011 Sep;50(9):938-948.e3. doi: 10.1016/j.jaac.2011.06.011. Epub 2011 Jul 31.
Pediatric obsessive-compulsive disorder is characterized by abnormalities of frontal-striatal-thalamic circuitry that appear near illness onset and persist over its course. Distinct frontal-striatal-thalamic loops through cortical centers for cognitive control (anterior cingulate cortex) and emotion processing (ventral medial frontal cortex) follow unique maturational trajectories, and altered connectivity within distinct loops may be differentially associated with OCD at specific stages of development.
Altered development of striatal and thalamic connectivity to medial frontal cortex was tested in 60 OCD patients compared with 61 healthy control subjects at child, adolescent, and adult stages of development, using resting-state functional connectivity MRI.
OCD in the youngest patients was associated with reduced connectivity of dorsal striatum and medial dorsal thalamus to rostral and dorsal anterior cingulate cortex, respectively. Increased connectivity of dorsal striatum to ventral medial frontal cortex was observed in patients at all developmental stages. In child patients, reduced connectivity between dorsal striatum and rostral anterior cingulate cortex correlated with OCD severity.
Frontal-striatal-thalamic loops involved in cognitive control are hypoconnected in young patients near illness onset, whereas loops implicated in emotion processing are hyperconnected throughout the illness.
儿科强迫症的特征是前额叶-纹状体-丘脑回路的异常，这些异常似乎在疾病发作前就出现了，并在疾病过程中持续存在。通过皮质中枢的认知控制（前扣带皮层）和情绪处理（腹内侧前额叶皮层）的不同额纹状体丘脑回路遵循独特的成熟轨迹，而不同回路中的连接改变可能与 OCD 在发育的特定阶段的特定表现有关。
使用静息状态功能磁共振成像技术，在儿童、青少年和成年阶段，对 60 名 OCD 患者和 61 名健康对照组进行了内侧前额叶皮质纹状体和丘脑连接改变的测试。
在年龄最小的患者中，背侧纹状体和内侧背侧丘脑与前扣带回的喙部和背侧的连接分别减少。在所有发育阶段的患者中，背侧纹状体与腹内侧前额叶皮层的连接增加。在儿童患者中，背侧纹状体与前扣带喙部之间的连接减少与 OCD 的严重程度相关。
在疾病发作前，涉及认知控制的额纹状体-纹状体-丘脑回路连接不足，而在整个疾病过程中，涉及情绪处理的回路连接过度。
