Cerebral metabolic correlates as potential predictors of response to anterior cingulotomy for obsessive compulsive disorder

Background: As interventions for severe, treatment-refractory obsessive com pulsive disorder (OCD), neurosurgical procedures are associated with only m odest efficacy. The purpose of this study was to identify cerebral metaboli c correlates as potential predictors of treatment response to anterior cing ulotomy for OCD. Methods: Clinical data were analyzed in the context of a retrospective desi gn. Subjects were 11 patients who underwent stereotactic anterior cinguloto my for OCD. Symptom severity was measured using the Yale-Brown Obsessive Co mpulsive Scale (Y-BOCS) before and at approximately 6 months postoperative. Preoperative F-18-fluorodeoxyglucose-positron emission tomography (FDG-PET ) data were available. Statistical parametric mapping methods were used to identify loci of significant correlation between preoperative regional cere bral metabolism and postoperative reduction in Y-BOCS scores. Results: One locus within right posterior cingulate cortex was identified, where preoperative metabolism was significantly correlated with improvement in OCD symptom severity following cingulotomy. Specifically, higher preope rative rates of metabolism at that locus were associated with better postop erative outcome. Conclusions: A possible predictor of treatment response was identified for patients with OCD undergoing anterior cingulotomy. Further research, utiliz ing a prospective design, is indicated to determine the validity and reliab ility of this finding. If confirmed, an index for noninvasively predicting response to cingulotomy for OCD would be of great value. (C) 2001 Society o f Biological Psychiatry.