In this study, we utilized proton magnetic resonance spectroscopy (MRS) to understand the role of glutamate (Glu), glutamine (Gln), and gamma-aminobutyric acid (GABA) of OCD patients in the pregenual anterior cingulate cortex (pgACC). In total, 54 patients with OCD and 54 healthy controls (HC) matched for age and sex were included in the study. They underwent MRS in the pgACC region to calculate the concentrations of Glu, Gln, GABA, and Glu + Gln (Glx). After quality control of the MRS data, 21 OCD and 21 HC were statistically analyzed. The severity of symptoms were evaluated using the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the statistical analysis, we compared differences between groups for the metabolites; in the OCD we analyzed the correlations with symptom severity, medication status, age, and duration of illness. A significant decrease in Glx, in Glu, and in Gln in the pgACC were observed in the OCD compared to HC. The correlation statistics showed a significant positive correlation between Glu levels and the YBOCS compulsions subscale. The results indicate that patients with OCD present a disturbance in glutamatergic metabolism in the pgACC. The results also demonstrate that these changes correlate with the severity of compulsions.
- MeSH
- cingulární gyrus * metabolismus MeSH
- GABA metabolismus MeSH
- glutamin metabolismus MeSH
- kyselina glutamová metabolismus MeSH
- lidé MeSH
- magnetická rezonanční spektroskopie metody MeSH
- obsedantně kompulzivní porucha * metabolismus MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Obsessive-compulsive disorder (OCD) is a chronic psychiatric illness and 1 of the most common anxiety disorders with the prevalence of 3%. Although its pathogenesis remains unclear, the traditional model focused on alternations in the serotonin system. Selective serotonin reuptake inhibitors provide the most effective treatment; however, as much as 40-60% of patients do not respond to antidepressants therapy. Thus, attention has shifted towards other neurotransmitter systems and related neuroanatomical structures. Recently, there is extensive evidence showing a key role of glutamate pathways abnormalities within the cortico-striatal-thalamo-cortical circuitry and temporal lobes in OCD pathogenesis. In this review, we link together the existent neuroanatomical, neurophysiological, and neuropsychological evidence to argue for potential benefits of adjuvant treatment with glutamatergic agents, especially memantine. By a targeted de-excitation effect on the glutamatergic system in the temporal lobes and connected brain regions, memantine might further alleviate OCD symptoms. This effect should be even more pronounced in certain subtypes of patients with specific cognitive deficits and maladaptive compensatory memory processes (e.g., checkers).
- MeSH
- glutamátové receptory metabolismus MeSH
- kognitivní poruchy etiologie MeSH
- kyselina glutamová metabolismus MeSH
- látky působící na systém excitačních aminokyselin terapeutické užití MeSH
- lidé MeSH
- mozek účinky léků metabolismus MeSH
- neuropsychologické testy MeSH
- obsedantně kompulzivní porucha komplikace farmakoterapie metabolismus patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Nemocný (20 let) s farmakorezistentní obsedantně-kompulzivní poruchou (OCD) byl léčen 3 týdny pomocí nízkofrekvenční rTMS (1 Hz, 20 min, 100 % MP). Během terapie došlo ke snížení psychopatologie o 32 % (Y-BOCS) a ke snížení metabolizmu (18FDG PET) dolní frontální kůry, caudata a dalších oblastí. Pozorování dokumentuje, že rTMS může terapeuticky zasahovat do klíčových patofyziologických mechanizmů OCD.
The patient (20 years old) with a pharmacoresistant form of obsessive-compulsive disorder (OCD) was treated for 3 weeks by the low-frequency rTMS (1 Hz, 20 min., 100% MT). A 32% decrease in the psychopathology (Y-BOCS) was observed during rTMS treatment. The regional brain metabolism (18FDG PET) decreased in the prefrontal cortex, caudate, and other regions. The case report demonstrates that rTMS could therapeutically interfere with the causal pathophysiologic mechanisms of OCD.
- MeSH
- deoxyglukosa MeSH
- dospělí MeSH
- finanční podpora výzkumu jako téma MeSH
- fyzikální stimulace metody přístrojové vybavení MeSH
- lidé MeSH
- magnetismus MeSH
- obsedantně kompulzivní porucha metabolismus patofyziologie terapie MeSH
- prefrontální mozková kůra metabolismus MeSH
- tomografie emisní počítačová MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- přehledy MeSH
