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Kellogg MA, Ernst LD, Spencer DC, Datta P, Klein E, Bhati MT, Shivacharan RS, Nho YH, Barbosa DAN, Halpern CH, Raslan A. Dual Treatment of Refractory Focal Epilepsy and Obsessive-Compulsive Disorder With Intracranial Responsive Neurostimulation. Neurol Clin Pract 2024; 14:e200318. [PMID: 38846467 PMCID: PMC11152646 DOI: 10.1212/cpj.0000000000200318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/02/2024] [Indexed: 06/09/2024]
Abstract
Purpose of the Review Intracranial neurostimulation is a well-established treatment of neurologic conditions such as drug-resistant epilepsy (DRE) and movement disorders, and there is emerging evidence for using deep brain stimulation to treat obsessive-compulsive disorder (OCD) and depression. Nearly all published reports of intracranial neurostimulation have focused on implanting a single device to treat a single condition. The purpose of this review was to educate neurology clinicians on the background literature informing dual treatment of 2 comorbid neuropsychiatric conditions epilepsy and OCD, discuss ethical and logistical challenges to dual neuropsychiatric treatment with a single device, and demonstrate the promise and pitfalls of this approach through discussion of the first-in-human closed-looped responsive neurostimulator (RNS) implanted to treat both DRE (on-label) and OCD (off-label). Recent Findings We report the first implantation of an intracranial closed-loop neurostimulation device (the RNS system) with the primary goal of treating DRE and a secondary exploratory goal of managing treatment-refractory OCD. The RNS system detects electrophysiologic activity and delivers electrical stimulation through 1 or 2 electrodes implanted into a patient's seizure-onset zones (SOZs). In this case report, we describe a patient with treatment-refractory epilepsy and OCD where the first lead was implanted in the right superior temporal gyrus to target the most active SOZ based on stereotactic EEG (sEEG) recordings and semiology. The second lead was implanted to target the right anterior peri-insular region (a secondary SOZ on sEEG) with the distal-most contacts in the right nucleus accumbens, a putative target for OCD neurostimulation treatment. The RNS system was programmed to detect and record the unique electrophysiologic signature of both the patient's seizures and compulsions and then deliver tailored electrical pulses to disrupt the pathologic circuitry. Summary Dual treatment of refractory focal epilepsy and OCD with an intracranial closed-loop neurostimulation device is feasible, safe, and potentially effective. However, there are logistical challenges and ethical considerations to this novel approach to treatment, which require complex care coordination by a large multidisciplinary team.
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Affiliation(s)
- Marissa A Kellogg
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Lia D Ernst
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - David C Spencer
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Proleta Datta
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Eran Klein
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Mahendra T Bhati
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Rajat S Shivacharan
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Young-Hoon Nho
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Daniel A N Barbosa
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Casey H Halpern
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
| | - Ahmed Raslan
- Department of Neurology and Comprehensive Epilepsy Center (MAK, LDE, DCS, PD, EK), Oregon Health & Science University (OHSU); Department of Neurology (MAK, LDE, EK), Portland Veterans Affairs Healthcare System, OR; Department of Psychiatry and Behavioral Sciences (MTB); Department of Neurosurgery (MTB, RSS), Stanford University School of Medicine, CA; Department of Neurosurgery (Y-HN, DANB, CHH), University of Pennsylvania; Department of Surgery (CHH), Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; and Department of Neurosurgery and Comprehensive Epilepsy Center (AR), Oregon Health & Science University (OHSU) Department of Neurosurgery, Portland, OR
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Abdulrazeq H, Philips AP, Sastry R, Lauro PM, McLaughlin NCR, Asaad WF. The persistent value of lesions in psychiatric neurosurgery. Lancet Psychiatry 2024:S2215-0366(24)00115-9. [PMID: 38906167 DOI: 10.1016/s2215-0366(24)00115-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/23/2024] [Accepted: 04/03/2024] [Indexed: 06/23/2024]
Abstract
Neurosurgery for intractable psychiatric conditions has seen a resurgence with the increasing use of deep brain stimulation (DBS). Although DBS promises reversible neuromodulation and has become more popular than older lesioning methods, lesioning might still be preferred in specific cases. Here, we review the evidence for DBS and lesions in the treatment of intractable neuropsychiatric conditions and consider the factors that favour the continued use of lesioning procedures in appropriately selected cases. Broadly, systemic factors including comparative effectiveness, cost, and ethical arguments support an ongoing role for lesioning. Such a role is also supported by practical considerations including patient experiences of this type of therapy, the relative intensity of follow-up care, access to sparse or specialised follow-up care, and relative infection risk. Overall, we argue that neurosurgical lesion procedures remain an important alternative to DBS and their continued availability is necessary to fulfil the imperatives of mental health parity and enhance access to effective mental health treatments. Nonetheless, the efficacy of DBS and recent advances in closed-loop stimulation and remote programming might provide solutions to some of the challenges associated with wider use of electrical neuromodulation. Concerns about the scarcity of high-level evidence for the efficacy of lesioning procedures as well as the potential irreversible adverse effects of lesioning remain to be addressed.
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Affiliation(s)
- Hael Abdulrazeq
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Alexander P Philips
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Rahul Sastry
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Peter M Lauro
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nicole C R McLaughlin
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School, Brown University, Providence, RI, USA; Carney Institute for Brain Science, Brown University, Providence, RI, USA
| | - Wael F Asaad
- Department of Neurosurgery, The Warren Alpert Medical School, Brown University, Providence, RI, USA; Department of Neuroscience, Brown University, Providence, RI, USA; Carney Institute for Brain Science, Brown University, Providence, RI, USA
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3
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Csigó K, Münnich Á, Molnár J. The importance of examining early maladaptive schemas in the diagnosis and treatment of obsessive-compulsive disorder. Front Psychiatry 2024; 15:1360127. [PMID: 38800063 PMCID: PMC11116796 DOI: 10.3389/fpsyt.2024.1360127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/10/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas. Methods 112 participants (58 men and 54 women) diagnosed with OCD were involved in the study. The questionnaire package consisted of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire (PSWQ) and the Schema Questionnaire (SQ). Results We identified five early maladaptive schemas with a direct effect on the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the severity of the early maladaptive schemas, three significantly different groups could be identified in our sample: patients with mild, moderate and high schema-values. Among the groups significant differences can be found in the appearance and severity of compulsive symptoms, as well as in the presence of anxiety and depressive symptoms. But contrary to our expectations, not the severity, but the numberof the early maladaptive schemas showed a stronger correlation with the symptom variables. An additional result of our study derives from canonical correlation, addressing the relationship among early maladaptive schemas, OCD symptoms, anxiety and depressive symptoms from a new perspective. The results highlight that OCD is only one and not the most serious consequence of personality damage, indicated by early maladaptive schemas. Discussion The results of our study suggest that obsessive-compulsive disorder can be divided into several subgroups, which can be separated in terms of symptom severity, comorbid psychiatric symptoms and personality impairment patterns. The relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Our results strengthen the new dimensional view of OCD, which can determine the selection of the appropriate therapeutic treatment method beyond the diagnostic process.
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Affiliation(s)
- Katalin Csigó
- Institute of Psychology, Pázmány Péter Catholic University, Budapest, Hungary
- Psychotherapy Center, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
| | - Ákos Münnich
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Molnár
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Deveci N, Uğurlu M, Karakaş Uğurlu G, Kabadayi Şahin E, Erdoğan EÇ, Çayköylü A. The effects of psychological flexibility and resilience on psychopharmacological treatment response in patients with obsessive-compulsive disorder. Int Clin Psychopharmacol 2024; 39:181-186. [PMID: 37551600 DOI: 10.1097/yic.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a challenging psychiatric condition to treat. Previous research has explored various aspects of treatment response, but limited attention has been given to the significance of psychological flexibility and resilience. This study aimed to investigate the correlation between psychological flexibility, resilience, and different dimensions of OCD, as well as their role in treatment response specifically concerning OCD symptom sub-dimensions. The study involved 50 OCD patients and 42 healthy individuals as controls. Participants completed the Dimensional Obsessive-Compulsive Scale (DOCS), Acceptance and Action Questionnaire (AAQ-2), and Resilience Scale for Adults (RS). Initial scale scores were compared to post-treatment scores obtained after a 3-month follow-up using pharmacotherapy. The patient group exhibited significantly higher AAQ-2 scores and lower RS scores compared to the control group. During the post-treatment follow-up, a reduction in DOCS and AAQ-2 scores was observed, along with an increase in RS scores. The impact of differences in AAQ-2 and RS scores on the change in DOCS total scores was analyzed using mixed model linear regression analysis. The results showed a statistically significant effect of changes in AAQ-2 and RS sub-dimension scores on the change in DOCS total scores. The findings highlight the importance of flexibility and resilience in influencing treatment response among patients with OCD. When conventional pharmacotherapy and psychotherapy approaches prove insufficient, interventions focused on enhancing flexibility and resilience may contribute to improved treatment outcomes.
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Affiliation(s)
- Nisa Deveci
- Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine
| | - Mustafa Uğurlu
- Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine
| | | | - Esra Kabadayi Şahin
- Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine
| | | | - Ali Çayköylü
- Department of Psychiatry, Ankara Yildirim Beyazit University Faculty of Medicine
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5
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Stip E, Javaid SF, Abdel Aziz K, Arnone D. Happy Birthday "One Flew Over the Cuckoo's Nest": A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:887-893. [PMID: 37424267 PMCID: PMC10657581 DOI: 10.1177/07067437231182658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to 'correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients' selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.
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Affiliation(s)
- E. Stip
- Université de Montréal, Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - S. F. Javaid
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - K. Abdel Aziz
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - D. Arnone
- Department of Psychiatry and Behaviour Science, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
- Centre for Affective Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Li H, Yuan S, Dai L, Huang H, Lin Z, Zhan S, Luo J, Liu W, Sun B. Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorder: A Tractography and Lesion Geometry study. Stereotact Funct Neurosurg 2023; 101:407-415. [PMID: 37926091 DOI: 10.1159/000534312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/21/2023] [Indexed: 11/07/2023]
Abstract
INTRODUCTION A bilateral anterior capsulotomy effectively treats refractory obsessive-compulsive disorder (OCD). We investigated the geometry of lesions and disruption of white matter pathways within the anterior limb of the internal capsule (ALIC) in patients with different outcomes. METHODS In this retrospective study, we analyzed data from 18 patients with refractory OCD who underwent capsulotomies. Patients were grouped into "responders" and "nonresponders" based on the percentage of decrease in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) after surgery. We investigated neurobehavioral adverse effects and analyzed the overlap between lesions and the ventromedial prefrontal (vmPFC) and dorsolateral prefrontal (dlPFC) pathways. Probabilistic maps were constructed to investigate the relationship between lesion location and clinical outcomes. RESULTS Of the 18 patients who underwent capsulotomies, 12 were responders (>35% improvement in YBOCS), and six were nonresponders. The vmPFC pathway was more involved than the dlPFC pathway in responders (p = 0.01), but no significant difference was observed in nonresponders (p = 0.10). The probabilistic voxel-wise efficacy map showed a relationship between ventral voxels within the ALIC with symptom improvement. Weight gains occurred in 11/18 (61%) patients and could be associated with medial voxels within the ALIC. CONCLUSION The optimal outcome after capsulotomy in refractory OCD is linked to vmPFC disruption in the ALIC. Medial voxels within the ALIC could be associated with weight gains following capsulotomy.
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Affiliation(s)
- Hongyang Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,
| | - Siyu Yuan
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Lulin Dai
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikun Zhan
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jie Luo
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Liu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Chang JG, Kim SJ, Kim CH. Neuroablative Intervention for Refractory Obsessive-Compulsive Disorder. Psychiatry Investig 2023; 20:997-1006. [PMID: 37997327 PMCID: PMC10678146 DOI: 10.30773/pi.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE This review aims to investigate the progression of neuroablation, along with documented clinical efficacy and safety, in the management of treatment-resistant obsessive-compulsive disorder (OCD). METHODS We searched and compiled clinical research results of neuroablation therapy reported to date. We extracted outcomes related to clinical efficacy, side effects, and surgical complications. Additionally, we summarized key claims and findings. RESULTS Neuroablative intervention is a potential treatment approach for refractory OCD. Recent advancements, such as real-time magnetic resonance monitoring and minimally invasive techniques employing ultrasound and laser, offer distinct advantages in terms of safety and comparative efficacy when compared to conventional methods. However, the absence of randomized controlled trials and long-term outcome data underscores the need for cautious consideration when selecting neuroablation. CONCLUSION Neuroablative intervention shows promise for refractory OCD, but vigilant consideration is essential in both patient selection and surgical method choices due to the potential for rare yet serious complications.
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Affiliation(s)
- Jhin Goo Chang
- Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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8
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Laseca-Zaballa G, Lubrini G, Periañez JA, Simón-Martínez V, Martín Bejarano M, Torres-Díaz C, Martínez Moreno N, Álvarez-Linera J, Martínez Álvarez R, Ríos-Lago M. Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review. Neurosurg Rev 2023; 46:145. [PMID: 37351641 PMCID: PMC10289910 DOI: 10.1007/s10143-023-02037-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 04/26/2023] [Accepted: 05/22/2023] [Indexed: 06/24/2023]
Abstract
Neurosurgery is a therapeutic option for patients with refractory obsessive-compulsive disorder who do not respond to previous treatments. Although its efficacy in reducing clinical symptomatology has been proven, few studies have analyzed its effects at the cognitive level. The aim of this systematic review was to describe the cognitive outcomes of functional neurosurgery in patients that went through capsulotomies or cingulotomies. PubMed, Medline, Scopus, PsycInfo, PsyArticles, and Web of Knowledge were searched for studies reporting cognitive outcomes in refractory obsessive-compulsive patients after capsulotomies and cingulotomies. The risk of bias was assessed with the Assessment Tool for Before-After (Pre-Post) Studies With No Control Group tool; 13 studies met inclusion criteria, including 205 refractory obsessive-compulsive disorder patients for both surgical procedures. Results showed a substantial number of studies that did report significant cognitive improvement after surgery, being this improvement specially related to memory and executive functions. The second-most frequent finding is the maintenance of cognitive performance (nor improvement or worsening). From a neuropsychological point of view, this outcome might be considered a success, given that it is accompanied by amelioration of obsessive-compulsive symptoms. Subtle cognitive adverse effects have also been reported. Neurosurgery procedures appear to be safe from a cognitive point of view. Methodological issues must be improved to draw clearer conclusions, but capsulotomies and cingulotomies constitute an effective alternative treatment for refractory obsessive-compulsive disorder patients.
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Affiliation(s)
- G Laseca-Zaballa
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
| | - G Lubrini
- Department of Basic Psychology II, UNED, Madrid, Spain
| | - J A Periañez
- Department of Experimental Psychology, Cognitive Processes and Speech Therapy, Complutense University of Madrid, Madrid, Spain
| | | | - M Martín Bejarano
- Neuropsychology Service, Fidias Health & Sport, Cádiz, Spain
- Faculty of Medicine, University of Cádiz, Cádiz, Spain
| | - C Torres-Díaz
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - N Martínez Moreno
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - J Álvarez-Linera
- Department of Radiodiagnosis, Ruber International Hospital, Madrid, Spain
| | - R Martínez Álvarez
- Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain
| | - M Ríos-Lago
- Department of Basic Psychology II, UNED, Madrid, Spain.
- Brain Damage Service, Beata Maria Ana Hospital, Madrid, Spain.
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Asher R, Hyun I, Head M, Cosgrove GR, Silbersweig D. Neuroethical implications of focused ultrasound for neuropsychiatric illness. Brain Stimul 2023; 16:806-814. [PMID: 37150289 DOI: 10.1016/j.brs.2023.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/17/2023] [Accepted: 04/23/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND MR-guided focused ultrasound is a promising intervention for treatment-resistant mental illness, and merits contextualized ethical exploration in relation to more extensive ethical literature regarding other psychosurgical and neuromodulation treatment options for this patient population. To our knowledge, this topic has not yet been explored in the published literature. OBJECTIVE The purpose of this paper is to review and discuss in detail the neuroethical implications of MR-guided focused ultrasound for neuropsychiatric illness as an emerging treatment modality. METHODS Due to the lack of published literature on the topic, the approach involved a detailed survey and review of technical and medical literature relevant to focused ultrasound and established ethical issues related to alternative treatment options for patients with treatment-resistant, severe and persistent mental illness. The manuscript is structured according to thematic and topical findings. RESULTS This technology has potential benefits for patients suffering with severe mental illness, compared with established alternatives. The balance of technical, neuroscientific and clinical considerations should inform ethical deliberations. The nascent literature base, nuances in legal classification and permissibility depending upon jurisdiction, influences of past ethical issues associated with alternative treatments, tone and framing in media articles, and complexity of clinical trials all influence ethical assessment and evaluations of multiple stakeholders. Recommendations for future research are provided based on these factors. CONCLUSION Salient ethical inquiry should be further explored by researchers, clinicians, and ethicists in a nuanced manner methodologically, one which is informed by past and present ethical issues related to alternative treatment options, broader psychiatric treatment frameworks, pragmatic implementation challenges, intercultural considerations, and patients' ethical concerns.
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Affiliation(s)
- Rachel Asher
- Brigham and Women's Hospital/Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA.
| | - Insoo Hyun
- Center for Bioethics at Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA.
| | - Mitchell Head
- Te Kotahi Research Institute/University of Waikato, Gate 4C, 194H Hillcrest Rd, Hillcrest, Hamilton, 3216, Aotearoa, New Zealand.
| | - G Rees Cosgrove
- Brigham and Women's Hospital/Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA.
| | - David Silbersweig
- Brigham and Women's Hospital/Harvard Medical School, 60 Fenwood Rd, Boston, MA, 02115, USA.
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10
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Gadot R, Najera R, Hirani S, Anand A, Storch E, Goodman WK, Shofty B, Sheth SA. Efficacy of deep brain stimulation for treatment-resistant obsessive-compulsive disorder: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328738. [PMID: 36127157 DOI: 10.1136/jnnp-2021-328738] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
Deep brain stimulation (DBS) is an established and growing intervention for treatment-resistant obsessive-compulsive disorder (TROCD). We assessed current evidence on the efficacy of DBS in alleviating OCD and comorbid depressive symptoms including newly available evidence from recent trials and a deeper risk of bias analysis than previously available. PubMed and EMBASE databases were systematically queried using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. We included studies reporting primary data on multiple patients who received DBS therapy with outcomes reported through the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Primary effect measures included Y-BOCS mean difference and per cent reduction as well as responder rate (≥35% Y-BOCS reduction) at last follow-up. Secondary effect measures included standardised depression scale reduction. Risk of bias assessments were performed on randomised controlled (RCTs) and non-randomised trials. Thirty-four studies from 2005 to 2021, 9 RCTs (n=97) and 25 non-RCTs (n=255), were included in systematic review and meta-analysis based on available outcome data. A random-effects model indicated a meta-analytical average 14.3 point or 47% reduction (p<0.01) in Y-BOCS scores without significant difference between RCTs and non-RCTs. At last follow-up, 66% of patients were full responders to DBS therapy. Sensitivity analyses indicated a low likelihood of small study effect bias in reported outcomes. Secondary analysis revealed a 1 standardised effect size (Hedges' g) reduction in depressive scale symptoms. Both RCTs and non-RCTs were determined to have a predominantly low risk of bias. A strong evidence base supports DBS for TROCD in relieving both OCD and comorbid depression symptoms in appropriately selected patients.
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Affiliation(s)
- Ron Gadot
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ricardo Najera
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Samad Hirani
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Adrish Anand
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Eric Storch
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne K Goodman
- Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ben Shofty
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
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11
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Satzer D, Mahavadi A, Lacy M, Grant JE, Warnke P. Interstitial laser anterior capsulotomy for obsessive-compulsive disorder: lesion size and tractography correlate with outcome. J Neurol Neurosurg Psychiatry 2022; 93:317-323. [PMID: 34716192 DOI: 10.1136/jnnp-2021-327730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anterior capsulotomy is a well-established treatment for refractory obsessive-compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging. OBJECTIVE To characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement. METHODS Patients with severe OCD refractory to pharmacotherapy and cognitive-behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography. RESULTS Eighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3-51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4-1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal-ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001). CONCLUSIONS Laser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal-subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.
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Affiliation(s)
- David Satzer
- Neurosurgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Anil Mahavadi
- Neurosurgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maureen Lacy
- Psychaitry and Behavioral Neuroscience, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Jon E Grant
- Psychiatry, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Peter Warnke
- Neurosurgery, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
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12
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Davidson B, Eapen-John D, Mithani K, Rabin JS, Meng Y, Cao X, Pople CB, Giacobbe P, Hamani C, Lipsman N. Lesional psychiatric neurosurgery: meta-analysis of clinical outcomes using a transdiagnostic approach. J Neurol Neurosurg Psychiatry 2022; 93:207-215. [PMID: 34261748 DOI: 10.1136/jnnp-2020-325308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 06/20/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Four ablative neurosurgical procedures are used in the treatment of refractory psychiatric illness. The long-term effects of these procedures on psychiatric symptoms across disorders has never been synthesised and meta-analysed. METHODS A preregistered systematic review was performed on studies reporting clinical results following ablative psychiatric neurosurgery. Four possible outcome measures were extracted for each study: depression, obsessive-compulsive symptoms, anxiety and clinical global impression. Effect sizes were calculated using Hedge's g. Equipercentile linking was used to convert symptom scores to a common metric. The main outcome measures were the magnitude of improvement in depression, obsessive compulsive symptoms, anxiety and clinical global impression. The secondary outcome was a subgroup analysis comparing the magnitude of symptom changes between the four procedures. RESULTS Of 943 articles, 43 studies reporting data from 1414 unique patients, were included for pooled effects estimates with a random-effects meta-analysis. Results showed that there was a large effect size for improvements in depression (g=1.27; p<0.0001), obsessive-compulsive symptoms (g=2.25; p<0.0001) and anxiety (g=1.76; p<0.0001). The pooled clinical global impression improvement score was 2.36 (p<0.0001). On subgroup analysis, there was only a significant degree of heterogeneity in effect sizes between procedure types for anxiety symptoms, with capsulotomy resulting in a greater reduction in anxiety than cingulotomy. CONCLUSIONS Contemporary ablative neurosurgical procedures were significantly associated with improvements in depression, obsessive-compulsive symptoms, anxiety and clinical global impression. PROSPERO REGISTRATION NUMBER CRD42020164784.
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Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - David Eapen-John
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Karim Mithani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Jennifer S Rabin
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Ying Meng
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Xingshan Cao
- Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Christopher B Pople
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada.,Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Clement Hamani
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Nir Lipsman
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada .,Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Sunnybrook Research Institute, Toronto, Ontario, Canada
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13
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Pattankar S, Sankhe M, Chavda K. Efficacy of Gamma Knife Radiosurgery in Refractory Obsessive-Compulsive Disorder: An Indian Experience. J Neurosci Rural Pract 2022; 13:23-31. [PMID: 35110917 PMCID: PMC8803525 DOI: 10.1055/s-0041-1740453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background Obsessive-compulsive disorder (OCD) is a chronic debilitating psychiatric condition with adverse impact on patient's sociooccupational health. Refractoriness to pharmacotherapy and psychotherapy is not uncommon. Gamma Knife radiosurgery (GKRS) is the comprehensively used and reviewed treatment modality in refractory OCD worldwide. In India, the past two decades of increasing GKRS availability has failed to create the necessary local awareness of its usefulness in refractory OCD. Limited native literature deepens the problem.
Objective To analyze our experience with GKRS in refractory OCD, and report the safety and efficacy/long-term outcome in patients using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS).
Materials and Methods A retrospective review of patients receiving GKRS for refractory OCD between 2000 and 2020 was carried out. Case files of the eligible (n = 9) patients were reviewed for clinical, radiotherapeutic, and outcome data. Additionally, patients were contacted via telephone to enquire about their experiences, and to obtain retroactive consent for GKRS in June 2021. Information obtained was collated, computed, and analyzed.
Results Male-to-female sex ratio was 8:1. Mean age at the time of GKRS and mean duration of OCD prior to GKRS was 30.1 ± 9.4 and 10.2 ± 5.8 years, respectively. Mean baseline Y-BOCS score was 29.6 ± 4.7. Our first patient received cingulotomy, while the rest underwent anterior capsulotomy. Median margin dose (50% isodose) was 70 Gy. Also, 23.8 ± 7.7 was the mean Y-BOCS score at the last follow-up (median = 30 months). Overall, 44.4% patients showed full/partial response (≥25% reduction in Y-BOCS score) at the last follow-up. In anterior capsulotomy (eight patients), patients with moderate/severe OCD showed better response (4/5 responders) than those with extreme OCD (0/3 responders). Single case of cingulotomy resulted in no response (<25% reduction in Y-BOCS score). No adverse radiation effects were noted. Also, 55.6% patients gave retroactive consent telephonically.
Conclusion GKRS is a safe and effective noninvasive treatment modality for refractory OCD. Ventral anterior capsule is the preferred target. Maximum radiation doses of 120 to 160 Gy are well tolerated. Extremely severe OCD cases fared poorer. Proper awareness about the availability and efficacy of GKRS in refractory OCD is required in India.
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Affiliation(s)
- Sanjeev Pattankar
- Department of Neurosurgery and Gamma Knife Radiosurgery, Parmanand Deepchand Hinduja Hospital & Medical Research Center, Mumbai, Maharashtra, India
| | - Milind Sankhe
- Department of Neurosurgery and Gamma Knife Radiosurgery, Parmanand Deepchand Hinduja Hospital & Medical Research Center, Mumbai, Maharashtra, India
| | - Kersi Chavda
- Department of Psychiatry, Parmanand Deepchand Hinduja Hospital & Medical Research Center, Mumbai, Maharashtra, India
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14
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Bouwens van der Vlis TA, Samanci Y, Ackermans L, Schruers KR, Temel Y, Leentjens AF, Dincer A, Peker S. Network analysis in Gamma Knife capsulotomy for intractable obsessive-compulsive disorder. BRAIN AND SPINE 2022; 2:100892. [PMID: 36248148 PMCID: PMC9562250 DOI: 10.1016/j.bas.2022.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Tim A.M. Bouwens van der Vlis
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Corresponding author. Department of Neurosurgery, Maastricht University Medical Center, Maastricht (MUMC+) PO Box 5800, 6202 AZ, Maastricht, the Netherlands
| | - Yavuz Samanci
- Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey
| | - Linda Ackermans
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Koen R.J. Schruers
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Y. Temel
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Albert F.G. Leentjens
- School of Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands
- Department of Psychiatry and Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Alp Dincer
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Selçuk Peker
- Department of Neurosurgery, School of Medicine, Koç University, Istanbul, Turkey
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15
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Ekmekçi Ertek İ, Uçar Ö, Emre Yaman M, Hakan Emmez Ö, Candansayar S. Treatment Outcomes of Gamma-Knife Radio Surgery in Refractory Obsessive-Compulsive Disorder. PSYCHIAT CLIN PSYCH 2021; 31:401-407. [PMID: 38765645 PMCID: PMC11079719 DOI: 10.5152/pcp.2021.21223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 09/05/2021] [Indexed: 05/22/2024] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a common disease that has negative effects on functionality, and 10% of the patients do not respond to first-line treatments. Gamma-knife radiosurgery (GKRS) has been used in patients with treatment-resistant OCD, but the data on long-term outcomes are still unsatisfactory. Methods In this study, 12 patients who underwent GKRS between 2005 and 2020 were evaluated retrospectively. Anterior capsulotomy was performed using two 4-mm isocenters at the midputaminal point of the anterior limb of the internal capsule on each side with a maximum radiation dose of 140-180 Gy. Patients were followed up with the Yale-Brown Obsession and Compulsion Scale (Y-BOCS), Montgomery-Asberg Depression Rating Scale (MADRS), and Brief Psychiatric Rating Scale (BPRS) on the first, third, and sixth months. Results After the procedure, a 35% reduction was observed in the overall Y-BOCS scores, and full response rate was 50%. There was a 49.5% decrease in the MADRS scores and a 57.8% decrease in the BPRS. Conclusion GKRS is an effective and non-invasive procedure with favorable side effects in treatment-resistant OCD with selected patients.
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Affiliation(s)
- İrem Ekmekçi Ertek
- Department of Psychiatry, Gazi University School of Medicine, Ankara, Turkey
| | - Önder Uçar
- Department of Psychiatry, Gazi University School of Medicine, Ankara, Turkey
| | - Mesut Emre Yaman
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Ömer Hakan Emmez
- Department of Neurosurgery, Gazi University School of Medicine, Ankara, Turkey
| | - Selçuk Candansayar
- Department of Psychiatry, Gazi University School of Medicine, Ankara, Turkey
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Etherington LA, Matthews K, Akram H. New Directions for Surgical Ablation Treatment of Obsessive Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:437-460. [PMID: 33565041 DOI: 10.1007/7854_2020_207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Although there are effective treatments available for many, probably most, patients with OCD, a significant number do not respond, or fail to experience a sustained beneficial response. For patients with such chronic, disabling and 'treatment-refractory' OCD, neurosurgical treatments may be considered. The best-established neurosurgical treatments are so-called ablative procedures, where targeted lesions are created with the intention of interrupting and modifying specific circuitry functions. There is a lengthy history of such procedures and a substantial literature although this is largely of an observational nature. However, both stereotactic radiosurgery (gamma knife) and MR-guided high intensity focused ultrasound are methods of lesion generation that lend themselves to the conduct of blinded randomised trial designs and these are beginning to be utilised. In this chapter, we present a narrative review of the key recent literature that describes the evidence for the safety and efficacy of lesion procedures for OCD. For context, we also consider the strength and quality of evidence relating to intensive residential treatment for OCD (sometimes proposed as an alternative to neurosurgery), furthermore, we also present some comparative data for lesion surgery and deep brain stimulation (DBS).
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Affiliation(s)
- Lori-An Etherington
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - Keith Matthews
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK.
| | - Harith Akram
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery (UCLH), London, UK
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