Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

D’Astous, Mireille; Cottin, Sylvine Carrondo; Roy, Marie‐Josée; Picard, Claude; Cantin, Léo

doi:10.1136/jnnp-2012-303826

Cited by 56 publications

(60 citation statements)

References 30 publications

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“…38 For patients with OCD who underwent AC, one study found no difference in the presurgery YBOCS scores between patients who responded to surgery and nonresponders. 8 In contrast, the average presurgery YBOCS scores of nonresponders (YBOCS score < 35% improvement) at the Karolinska Institute was 35 (SD 3), compared with 32 (SD 3) for patients who had a clinically significant response (p = 0.02), suggesting that OCD symptom severity may have a negative predictive value for treatment response. 37 Moreover, worse OCD severity is also associated with a higher number of comorbidities, particularly generalized anxiety disorder and agoraphobia.…”

Section: Severity Of Ocdmentioning

confidence: 71%

“…Of these, 10 studies included 108 patients with capsulotomy 5,7,8,17,23,26,28,32,37,41 and 10 included 62 patients who underwent DBS. 1,9,13,14,18,19,21,35,36,47 Table 1 (AC) and Table 2 (DBS) present details of the number of patients in each study, age at surgery, length of follow-up, details of the surgical procedures, and pre-and postoperative YBOCS scores.…”

Section: Resultsmentioning

confidence: 99%

“…23 Conversely, in another ablative study the average duration of OCD was 12 years for patients who had a clinically relevant response (YBOCS improvement > 25%) versus 20 years for patients who did not respond. 8 These conflicting results from small clinical studies make it difficult to assess whether duration of OCD is a predictor of treatment outcome after neurosurgery. Moreover, without detailed clinical vignettes, it is difficult to know if chronicity represents longer periods of treatment quiescence (and hence neurosurgery would be unnecessary earlier on) or a more medically refractory OCD course.…”

Section: Duration Of Ocdmentioning

confidence: 99%

“…31 D'Astous and colleagues reported on 19 patients who underwent mechanical AC in Quebec. 8 The average age of patients who "responded" to treatment (defined in that study as > 25% improvement in YBOCS score) was 37.5 years (SD 12.3) compared with 44.4 years (SD 10.2) for patients who did not respond. While the so-called responder group was younger, this difference was not statistically significant.…”

Section: Patient Age At Surgerymentioning

confidence: 99%

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Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Pepper

Hariz

Zrinzo

2015

JNS

101

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Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition. Traditionally, anterior capsulotomy (AC) was an established procedure for treatment of patients with refractory OCD. Over recent decades, deep brain stimulation (DBS) has gained popularity. In this paper the authors review the published literature and compare the outcome of AC and DBS targeting of the area of the ventral capsule/ventral striatum (VC/VS) and nucleus accumbens (NAcc). Patients in published cases were grouped according to whether they received AC or DBS and according to their preoperative scores on the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and then separated according to outcome measures: remission (YBOCS score < 8); response (≥ 35% improvement in YBOCS score); nonresponse (< 35% improvement in YBOCS score); and unfavorable (i.e., worsening of the baseline YBOCS score). Twenty studies were identified reporting on 170 patients; 62 patients underwent DBS of the VC/VS or the NAcc (mean age 38 years, follow-up 19 months, baseline YBOCS score of 33), and 108 patients underwent AC (mean age 36 years, follow-up 61 months, baseline YBOCS score of 30). In patients treated with DBS there was a 40% decrease in YBOCS score, compared with a 51% decrease for those who underwent AC (p = 0.004). Patients who underwent AC were 9% more likely to go into remission than patients treated with DBS (p = 0.02). No difference in complication rates was noted. Anterior capsulotomy is an efficient procedure for refractory OCD. Deep brain stimulation in the VC/VS and NAcc area is an emerging and promising therapy. The current popularity of DBS over ablative surgery for OCD is not due to nonefficacy of AC, but possibly because DBS is perceived as more acceptable by clinicians and patients.

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Section: Severity Of Ocdmentioning

confidence: 71%

Section: Resultsmentioning

confidence: 99%

Section: Duration Of Ocdmentioning

confidence: 99%

Section: Patient Age At Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Pepper

Hariz

Zrinzo

2015

JNS

101

View full text Add to dashboard Cite

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“…Объем, локализация и МР-харак-теристики очагов, получаемых при ультразвуковой де-струкции, совпадают с таковыми при радиочастотной термоабляции [22,36,37]. При этом эффективность уль-тразвуковой деструкции представляется сопоставимой с эффективностью радиочастотной термоабляции, а также стимуляции глубинных структур [18,19,22,32,35,[38][39][40][41][42][43][44]. Из всех деструктивных методик ФУЗ представляется наи-более оптимальной, так как эта процедура, в отличие от прямой стереотаксической радиочастотной абляции, ис-ключает риски внутримозговых кровоизлияний, инфици-рования и др., и по сравнению с радиохирургическим ле-чением характеризуется возможностью физиологической верификации, предсказуемостью результата и быстрым развитием эффекта [19,[45][46][47].…”

Section: обзорыunclassified

The use of transcranial focused ultrasound in CNS diseases

Galkin

2016

Vopr. neirokhir.

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Транскраниальный фокусированный ультразвук -это современная медицинская технология, которая позволяет неинва-зивно оказывать воздействие на головной мозг. Современный этап развития этой методики насчитывает не более 20 лет и многие возможные приложения технологии находятся только на этапе доклинических исследований. Наибольший про-гресс достигнут в области функциональной нейрохирургии: фокусированный ультразвук позволяет неинвазивно под постоянным контролем МРТ создавать небольшие очаги деструкции в соответствующих мишенях, обеспечивая лечебные нейромодулирующие эффекты при болезни Паркинсона, эссенциальном треморе, болевых синдромах, обсессивно-ком-пульсивных расстройствах и других заболеваниях. На настоящий момент данное лечение проведено более чем у 300 пациентов. Опубликованы единичные случаи ультразвуковой термодеструкции интракраниальных новообразований. На животных проводятся попытки проведения ультразвуковой третьей вентрикулостомии. Отдельное направление посвя-щено увеличению проницаемости гематоэнцефалического барьера для различных веществ под воздействием фокусиро-ванного ультразвука. В лабораториях исследуется возможность увеличения проницаемости для химиопрепаратов, иммун-ных препаратов и других веществ. Большое количество работ направлено на лечение болезни Альцгеймера. Начаты кли-нические исследования увеличения проницаемости гематоэнцефалического барьера для химиопрепаратов. Еще одним недеструктивным эффектом, который в настоящее время активно исследуется на животных, является способность фоку-сированного ультразвука оказывать обратимое нейромодулирующее -стимулирующее и ингибирующее -действие на структуры нервной системы. Также в лабораторных исследованиях продемонстрирована способность фокусированного ультразвука разрушать сгустки крови и тромбы. Транскраниальный фокусированный ультразвук представляет множество уникальных возможностей для научной и прак-тической медицинской деятельности. Широкому внедрению в клинику будет предшествовать большая исследовательская работа. Тем не менее уже сейчас можно утверждать, что внедрение этой технологии значительно расширит диагностиче-ские и лечебные возможности в нейрохирургии и неврологии. Ключевые слова: ультразвук, фокусированный ультразвук, нейрохирургия, функциональная нейрохирургия, гематоэнцефалический барьер. The use of transcranial focused ultrasound in CNS diseases M.V. GALKIN Burdenko Neurosurgical Institute, Moscow, RussiaTranscranial focused ultrasound is a modern medical technique, which provides non-invasive impact on the brain. Current development stage of this technique is no longer than 20 years and many possible applications of this technique are still at preclinical stage. The greatest progress has been made in the field of functional neurosurgery. Focused ultrasound enables noninvasive MRI-guided formation of small destruction foci in the relevant targets, providing therapeutic neuromodulating effects in patients with Parkinson's disease, essential tremor, pain syndromes, obsessive-compulsive disorders, and other diseases. So far, thi...

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Neuroanatomical Characteristics Associated With Response to Dorsal Anterior Cingulotomy for Obsessive-Compulsive Disorder

et al. 2015

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IMPORTANCE Approximately 10% of patients with obsessive-compulsive disorder (OCD) have symptoms that are refractory to pharmacologic and cognitive-behavioral therapies. Neurosurgical interventions can be effective therapeutic options in these patients, but not all individuals respond. The mechanisms underlying this response variability are poorly understood. OBJECTIVE To identify neuroanatomical characteristics on preoperative imaging that differentiate responders from nonresponders to dorsal anterior cingulotomy, a neurosurgical lesion procedure used to treat refractory OCD. DESIGN, SETTING, AND PARTICIPANTS We retrospectively analyzed preoperative T1 and diffusion magnetic resonance imaging sequences from 15 patients (9 men and 6 women) who underwent dorsal anterior cingulotomy. Eight of the 15 patients (53%) responded to the procedure. MAIN OUTCOMES AND MEASURES We used voxel-based morphometry (VBM) and diffusion tensor imaging to identify structural and connectivity variations that could differentiate eventual responders from nonresponders. The VBM and probabilistic tractography metrics were correlated with clinical response to the cingulotomy procedure as measured by changes in the Yale-Brown Obsessive Compulsive Scale score. RESULTS Voxel-based morphometry analysis revealed a gray matter cluster in the right anterior cingulate cortex, anterior to the eventual lesion, for which signal strength correlated with poor response (P = .017). Decreased gray matter in this region of the dorsal anterior cingulate cortex predicted improved response (mean [SD] gray matter partial volume for responders vs nonresponders, 0.47 [0.03] vs 0.66 [0.03]; corresponding to mean Yale-Brown Obsessive Compulsive Scale score change, −60% [19] vs −11% [9], respectively). Hemispheric asymmetry in connectivity between the eventual lesion and the caudate (for responders vs nonresponders, mean [SD] group laterality for individual lesion seeds, −0.79 [0.18] vs −0.08 [0.65]; P = .04), putamen (−0.55 [0.35] vs 0.50 [0.33]; P = .001), thalamus (−0.82 [0.19] vs 0.41 [0.24]; P = .001), pallidum (−0.78 [0.18] vs 0.43 [0.48]; P = .001), and hippocampus (−0.66 [0.33] vs 0.33 [0.18]; P = .001) also correlated significantly with clinical response, with increased right-sided connectivity predicting greater response. CONCLUSIONS AND RELEVANCE We identified features of anterior cingulate cortex structure and connectivity that predict clinical response to dorsal anterior cingulotomy for refractory OCD. These results suggest that the variability seen in individual responses to a highly consistent, stereotyped procedure may be due to neuroanatomical variation in the patients. Furthermore, these variations may allow us to predict which patients are most likely to respond to cingulotomy, thereby refining our ability to individualize this treatment for refractory psychiatric disorders.

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Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

Abstract: Anterior capsulotomy is an effective and safe technique for the treatment of severe refractory OCD in patients who have no other alternative to improve their symptoms.

Cited by 56 publications

References 30 publications

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

The use of transcranial focused ultrasound in CNS diseases

Neuroanatomical Characteristics Associated With Response to Dorsal Anterior Cingulotomy for Obsessive-Compulsive Disorder

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