Obsessive-compulsive disorder secondary to focal brain lesions: from lesions to networks

Background: Obsessive-compulsive disorder (OCD) may develop following brain lesions, but lesion distribution and connectivity patterns are unknown. Methods: OCD-associated lesions, identified from systematic literature search, were traced on common brain space and compared to control lesions (N=608). Topography was analyzed using brain atlases, and lesion location networks computed using normative functional connectivity (N=1000). Lesional network maps (LNMs) were contrasted to data from primary OCD. Results: Among 129 case-descriptions of lesional OCD, traced lesions (n=40) were more specifically located in orbitofrontal cortex bilaterally and right temporal pole, and more connected to orbitofrontal cortex and ventral basal ganglia, bilaterally. LNMs overlapped with primary OCD functional peaks from Neurosynth, revealed abnormal functional connectivity in patients with primary OCD (n=54) compared to controls (n=61), and aligned with brain stimulation targets. Conclusions: Lesional OCD has specific patterns of brain lesion topography and functional connectivity, with LNMs associated to brain functional patterns in primary OCD.