Functional magnetic resonance imaging during planning before and after cognitive-behavioral therapy in pediatric obsessive-compulsive disorder

Objective: Pediatric obsessive compulsive disorder (OCD) has been associated with cognitive abnormalities, in particular executive impairments, and dysfunction of frontal-striatal-thalamic circuitry. The aim of this study was to investigate if planning as an executive function is compromised in pediatric OCD and is associated with frontal-striatal-thalamic dysfunction, and if this dysfunction would normalize after successful treatment.
Method: Twenty-five medication-free pediatric patients (mean ± SD 13.95 ± 2.52 years old, range 9 to 19 years) with OCD and 25 healthy controls, matched by age and gender, were scanned twice using a self-paced pseudo-randomized event-related functional magnetic resonance imaging version of the Tower of London. Patients were rescanned after 16 sessions of protocol-based cognitive behavioral therapy; healthy controls were rescanned after a similar interval.
Results: Patients performed the task significantly slower but with similar accuracy compared with controls. Neuroimaging results showed less recruitment of frontal and parietal regions in patients with OCD compared with controls during the planning versus control task. With increasing task load patients compared with controls showed more recruitment of ventrolateral and medial prefrontal cortex and insula and anterior cingulate cortex. After treatment, these differences ceased to be significant, with time by group by task load interaction analyses showing a significant decrease in right posterior prefrontal activity in patients with OCD compared with healthy controls.
Conclusion: Pediatric patients with OCD showed subtle planning impairments and decreased dorsolateral prefrontal and parietal recruitment that normalized after cognitive behavioral treatment. Planning dysfunction is likely to be a state rather than a trait feature of pediatric OCD.