Obsessive-compulsive disorder (OCD) is commonly associated with alterations in cortico-striato-thalamo-cortical brain networks. Yet, recent investigations of large-scale brain networks suggest that more diffuse alterations in brain connectivity may underlie its pathophysiology. Few studies have assessed functional connectivity within or between networks across the whole brain in pediatric OCD or how patterns of connectivity associate with treatment response. Resting-state functional magnetic resonance imaging scans were acquired from 25 unmedicated, treatment-naive children and adolescents with OCD (12.8 ± 2.9 years) and 23 matched healthy control (HC) participants (11.0 ± 3.3 years) before participants with OCD completed a course of cognitive-behavioral therapy (CBT). Participants were re-scanned after 12-16 weeks. Whole-brain connectomic analyses were conducted to assess baseline group differences and group-by-time interactions, corrected for multiple comparisons. Relationships between functional connectivity and OCD symptoms pre- and post-CBT were examined using longitudinal cross-lagged panel modeling. Reduced connectivity in OCD relative to HC participants was detected between default mode and task-positive network regions. Greater (less altered) connectivity between left angular gyrus and left frontal pole predicted better response to CBT in the OCD group. Altered connectivity between task-positive and task-negative networks in pediatric OCD may contribute to the impaired control over intrusive thoughts early in the illness. This is the first study to show that altered connectivity between large-scale network regions may predict response to CBT in pediatric OCD, highlighting the clinical relevance of these networks as potential circuit-based targets for the development of novel treatments.

中文翻译：

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改变的网络连接可预测小儿强迫症对认知行为治疗的反应。

强迫症 (OCD) 通常与皮质-纹状体-丘脑-皮质脑网络的改变有关。然而，最近对大规模大脑网络的研究表明，大脑连接的更广泛的改变可能是其病理生理学的基础。很少有研究评估儿科强迫症患者全脑网络内部或网络之间的功能连通性，或者连通性模式如何与治疗反应相关联。在强迫症参与者完成课程之前，对 25 名未接受药物治疗、未接受治疗的强迫症儿童和青少年（12.8 ± 2.9 岁）和 23 名匹配的健康对照 (HC) 参与者（11.0 ± 3.3 岁）进行静息状态功能磁共振成像扫描认知行为疗法（CBT）。参与者在 12-16 周后被重新扫描。进行全脑连接组学分析以评估基线组差异和组间相互作用，并针对多重比较进行校正。使用纵向交叉滞后面板模型检查功能连接性与 CBT 前后强迫症症状之间的关系。在默认模式和任务积极的网络区域之间检测到 OCD 相对于 HC 参与者的连接性降低。左角回和左额极之间更大（更少改变）的连接预示着强迫症组对 CBT 的更好反应。儿童强迫症中任务积极和任务消极网络之间的连接性改变可能导致疾病早期对侵入性想法的控制受损。