Magnetic Resonance–Guided Focused Ultrasound for Psychiatric Disorders

Davidson, Benjamin; Meng, Ying; Giacobbe, Peter; Hamani, Clement; Lipsman, Nir

doi:10.1002/cpt.1467

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…In addition, despite promising early reports, recent trials have been inconclusive in terms of the benefit [7][8][9][10][11] . Rapid advances in imaging and surgical technology has led to a revival in lesional procedures 12 . Unlike DBS, lesional procedures do not require a permanent implant, sparing patients the deviceprogramming visits and battery-replacement surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…Given that MRgFUS targeting the ALIC (MRgFUS-AC) generates lesions under real-time MRI and thermographic guidance, and does not involve open surgery or ionizing radiation, it offers the ability to perform more precise limbic lesions, possibly conferring a reduced risk of cognitive impairment when compared with RF and SRS 12 . A group based out of Seoul reported the first series of MRgFUS-AC, where they treated 11 patients with refractory OCD 37 .…”

Section: Introductionmentioning

confidence: 99%

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Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

et al. 2020

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Magnetic resonance-guided focused ultrasound (MRgFUS) anterior capsulotomy is a novel treatment option for patients with refractory obsessive compulsive disorder (OCD) or major depressive disorder (MDD). However, there is concern that lesional psychiatric surgery procedures may have adverse effects on cognition. In this study, we examined whether MRgFUS capsulotomy causes cognitive decline in patients with psychiatric illness. Ten patients with refractory OCD (n = 5) or MDD (n = 5) underwent MRgFUS capsulotomy. Cognitive functioning was measured at baseline as well as 6 months and 12 months postoperatively, with a battery of neuropsychological tests assessing domains of executive function, memory, and processing speed. Scores were analyzed at the individual-level, and changes ≥2 standard deviations were considered clinically significant. We also examined whether changes in clinical symptoms were associated with changes in cognitive performance. At baseline intellectual functioning was in the average to high-average range for the group. Following MRgFUS capsulotomy, there were no deteriorations in cognition that reached ≥2 standard deviations at 6 or 12 months. Eight out of ten patients demonstrated a ≥2 standard deviation improvement in at least one cognitive score at 6 or 12 months postoperatively. Improvements in clinical symptoms correlated significantly with self-reported improvements in frontal lobe function (p < 0.05), but not with objective measures of cognitive functioning. To summarize, MRgFUS capsulotomy did not result in cognitive decline in this cohort of patients with refractory OCD or MDD, suggesting that this procedure can be offered to patients with a very low risk of cognitive side effects.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

et al. 2020

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Section: Brain Stimulation Methods Used In Neurologic and Psychiatricmentioning

confidence: 99%

“…Our last treatment is not conventionally regarded as a form of brain stimulation but rather involves the modification of brain circuitry noninvasively through focused ultrasound. Davidson et al 25 describe here the use of this innovative method to deliver lesions to pathophysiological circuitry in the brain. This may have profound consequences both in relation to the ability of focused ultrasound to disrupt pathophysiologic circuitry in the brain but also to alter future drug delivery in brain regions where drug delivery may be compromised.…”

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confidence: 99%

A Physiological Marriage Made in Heaven: Treating and Measuring the Brain Through Stimulation

Daskalakis

Tyndale

2019

Clin Pharma and Therapeutics

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“…Lesional procedures can be carried out as open surgical procedures involving radio frequency (RF) thermoablation, or using less invasive techniques such as gamma-knife radiosurgery and -most recently -magnetic-resonance-guided focused ultrasound. [8][9][10] Thanks to remarkable neuroimaging advances over the past 2 decades, neurosurgical targets and DBS programming are now informed by structural, diffusion and functional connectivity MRI, as well as by fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) imaging. [11][12][13][14] Although MDD and OCD have their own distinct neuroimaging literature, both conditions display aberrant activity throughout the limbic frontostriatal circuit.…”

Section: Introductionmentioning

confidence: 99%

Predicting response to psychiatric surgery: a systematic review of neuroimaging findings

Davidson¹,

Suresh²,

Goubran³

et al. 2020

jpn

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Background: Psychiatric surgery, including deep brain stimulation and stereotactic ablation, is an important treatment option in severe refractory psychiatric illness. Several large trials have demonstrated response rates of approximately 50%, underscoring the need to identify and select responders preoperatively. Recent advances in neuroimaging have brought this possibility into focus. We systematically reviewed the psychiatric surgery neuroimaging literature to assess the current state of evidence for preoperative imaging predictors of response. Methods: We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) frameworks, and preregistered it using PROSPERO. We systematically searched the Medline, Embase and Cochrane databases for studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in patients who underwent psychiatric surgery. We recorded and synthesized the methodological details, imaging results and clinical correlations from these studies. Results: After removing duplicates, the search yielded 8388 unique articles, of which 7 met the inclusion criteria. The included articles were published between 2001 and 2018 and reported on the outcomes of 101 unique patients. Of the 6 studies that reported significant findings, all identified clusters of hypermetabolism, hyperconnectivity or increased size in the frontostriatal limbic circuitry. Limitations: The included studies were few and highly varied, spanning 2 decades. Conclusion: Although few studies have analyzed preoperative imaging for predictors of response to psychiatric surgery, we found consistency among the reported results: most studies implicated overactivity in the frontostriatal limbic network as being correlated with clinical response. Larger prospective studies are needed. Registration: www.crd.york.ac.uk/prospero/display_record.php?RecordID=131151.

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Magnetic Resonance–Guided Focused Ultrasound for Psychiatric Disorders

Cited by 8 publications

References 5 publications

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

A Physiological Marriage Made in Heaven: Treating and Measuring the Brain Through Stimulation

Predicting response to psychiatric surgery: a systematic review of neuroimaging findings

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