A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive–compulsive disorder: 2-year follow-up

Abstract

Bilateral thermal lesioning of the anterior limb of the internal capsule using MRgFUS may improve obsessive-compulsive, depressive and anxiety symptoms in patients with treatment-refractory OCD, without serious adverse effects.

Ventralis intermedius thalamotomy with focused ultrasound for patients with low skull density ratio

“…A lower SDR has been shown to correlate with a lower maximum temperature at the target . Although there has been no large‐scale statistical survey, according to Chang and colleagues and Kim and colleagues, 20.0% and 18.2% of patients had SDRs of 0.40 or less, respectively. At our hospital, 78.6% of patients have had SDRs of 0.40 or less.…”

Magnetic Resonance–Guided Focused Ultrasound for Psychiatric Disorders

“…Currently, psychiatric symptoms are believed to be driven by dysfunction in key limbic circuits, connecting cortical with subcortical structures . Task‐based and resting‐state functional magnetic resonance imaging studies have consistently implicated aberrant hyperactivity in cortical‐striatal‐thalamic‐cortical loops as a key feature of many psychiatric diseases, most notably MDD and OCD . Circuits that travel from the medial orbitofrontal and cingulate (anterior and subgenual) cortices to the ventral striatum and feedback through the dorsal‐medial thalamus are aberrantly hyperactive in these conditions .…”

“…This and other pathological limbic networks are highly interconnected through white matter tracts that converge or “bottleneck” through the anterior limb of the internal capsule (ALIC). As such, the ALIC has emerged as a potential target for many lesional treatments of psychiatric disorders …”

“…MRgFUS thalamotomy has recently become an established treatment for essential tremor, gaining the US Food and Drug Administration and Health Canada approval in 2016 after a successful randomized placebo‐controlled trial treating patients with refractory moderate‐to‐severe essential tremor . As a result, MRgFUS ablative procedures are currently being investigated in other conditions, including treatment‐resistant psychiatric conditions, where generating a lesion may be beneficial …”

“…Clinical trials are underway using MRgFUS to treat both MDD and OCD (http://www.clinicaltrials.gov). Published data in this field are promising but still very preliminary . By lessening the surgical risk involved in radiofrequency ablation or DBS, MRgFUS may also become a reasonable option for patients with moderate disease severity, or those previously deemed too ill for surgery.…”