Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response

Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.

Limited differences in fish and benthic communities and possible cascading effects inside and outside a protected marine area in Sagres (SW Portugal)

Marine protected areas (MPAs) are a relatively recent fisheries management and conservation tool for conservation of marine ecosystems and serve as experimental grounds to assess trophic cascade effects in areas were fishing is restricted to some extent. A series of descriptive field studies were performed to assess fish and benthic communities between two areas within a newly established MPA in SW Portugal. We characterized benthic macroalgal composition and determined the size, density and biomass of the main benthic predatory and herbivorous fish species as well as the main benthic herbivorous invertebrates to assess indications of top-down control on the phytobenthic assemblages. Fish species were identical inside and outside the MPA, in both cases Sarpa salpa was the most abundant fish herbivore and Diplodus spp. accounted for the great majority of the benthic predators. However, size and biomass of D. spp. were higher inside than outside the MPA. The main herbivorous invertebrate was the sea urchin Paracentrotus lividus, which was smaller and predominantly showing a crevice-dwelling behaviour in the MPA. In addition, P. lividus size frequency distribution showed a unimodal pattern outside and a bimodal pattern inside the MPA. We found significant differences in the algal assemblages between inside and outside the MPA, with higher abundance of turf and foliose algae inside, and articulated calcareous and corticated macrophytes outside the MPA, but no differences in the invasive Asparagopsis spp. The obtained results show differences in predatory fish and benthic community structure, but not in species richness, inside and outside the MPA. We hypothesize these differences lead to variation in species interactions: directly through predation and indirectly via affecting sea urchins behavioural patterns, predators might drive changes in macroalgal assemblages via trophic cascade in the study area. However due to non-biological differences between the two areas it is difficult to suggest that the MPA causes increased biological parameters of targeted species and to assess predatory control and trophic cascade effects in areas where fishing pressure is reduced. It is therefor advisable to design MPAs so that their impacts can be scientifically evaluated in a proper fashion.