Brain changes in children and adolescents with obsessive-compulsive disorder before and after treatment: a voxel-based morphometric MRI study.

The aim of this study is to determine whether children and adolescents with treatment-naïve obsessive-compulsive disorder (OCD) present brain structure differences in comparison with healthy subjects, and to evaluate brain changes after treatment and clinical improvement. Initial and 6 months' follow-up evaluations were performed in 15 children and adolescents (age range=9-17 years, mean=13.7, S.D.=2.5; 8 male, 7 female) with DSM-IV OCD and 15 healthy subjects matched for age, sex and estimated intellectual level. An evaluation with psychopathological scales and magnetic resonance imaging (MRI) was carried out at admission and after 6 months' follow-up. Axial three-dimensional T1-weighted images were obtained in a 1.5 T scanner and analysed using optimized voxel-based morphometry (VBM) and longitudinal VBM approaches. Compared with controls, OCD patients presented significantly less gray matter volume bilaterally in right and left parietal lobes and right parietal white matter (P=0.001 FWE corrected) at baseline evaluation. After 6 months of treatment, and with a clear clinical improvement, the differences between OCD patients and controls in the parietal lobes in gray and white matter were no longer statistically significant. During follow-up in the longitudinal study, an increase in gray matter volume in the right striatum of OCD patients was observed, though the difference was not statistically significant. Children and adolescents with untreated OCD present gray and white matter decreases in lateral parietal cortices, but this abnormality is reversible after clinical improvement.