Results of Gamma Knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients

Abstract

OBJECTIVE Obsessive-compulsive disorder (OCD) is a severe psychiatric condition. The authors present their experience with Gamma Knife radiosurgery (GKRS) in the treatment of patients with OCD resistant to any medical therapy. METHODS Patients with severe OCD resistant to all pharmacological and psychiatric treatments who were treated with anterior GKRS capsulotomy were retrospectively reviewed. These patients were submitted to a physical, neurological, and neuropsychological examination together with structural and functional MRI before and after GKRS treatment. Strict study inclusion criteria were applied. Radiosurgical capsulotomy was performed using two 4-mm isocenters targeted at the midputaminal point of the anterior limb of the capsule. A maximal dose of 120 Gy was prescribed for each side. Clinical global changes were assessed using the Clinical Global Impression (CGI) scale, Global Assessment of Functioning (GAF) scale, EQ-5D, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). OCD symptoms were determined by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS Ten patients with medically refractory OCD (5 women and 5 men) treated between 2006 and 2015 were included in this study. Median age at diagnosis was 22 years, median duration of illness at the time of radiosurgery was 14.5 years, and median age at treatment was 38.8 years. Before GKRS, the median Y-BOCS score was 34.5 with a median obsession score of 18 and compulsion score of 17. Seven (70%) of 10 patients achieved a full response at their last follow-up, 2 patients were nonresponders, and 1 patient was a partial responder. Evaluation of the Y-BOCS, BDI, STAI-Trait, STAI-State, GAF, and EQ-5D showed statistically significant improvement at the last follow-up after GKRS. Neurological examinations were normal in all patients at each visit. At last follow-up, none of the patients had experienced any significant adverse neuropsychological effects or personality changes. CONCLUSIONS GKRS anterior capsulotomy is effective and well tolerated with a maximal dose of 120 Gy. It reduces both obsessions and compulsions, improves quality of life, and diminishes depression and anxiety.

Sustained Relief after Pallidal Stimulation Interruption in Tourette’s Syndrome Treated with Simultaneous Capsulotomy

“…Recent reports have shown that GPi-DBS combined with capsulotomy is associated with significant long-term improvements which is quickly be evident in the patients’ TS symptoms and psychiatric comorbidities, along with sustained improvements in adaptive function and quality of life [17, 18, 31]. The temporary side effects such as weight gain, apathy, fatigue, and confusion, as well as, childish behaviors can occur after capsulotomy [32, 33]. In this study, we retrospectively assessed the clinical outcomes of several patients with severe and medication-refractory TS and psychiatric comorbidities who had been treated with bilateral GPi-DBS combined with capsulotomy but who intentionally or accidentally experienced a discontinuation of DBS during their treatment course.…”

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

“…The interventions used were ALIC DBS, 41,42 RF cingulotomy, 40,43 RF capsulotomy 45 and gamma-knife radio surgery capsulotomy. 44 Although all 7 studies addressed the concept of preoperative imaging predictors of response, only those by Rauch and colleagues 39 and Banks and colleagues 43 were primarily aimed at identifying preoperative neuroimaging predictors of response.…”

“…Spatola and colleagues 44 reported a series of 10 patients with OCD who underwent gamma-knife radiosurgery capsulotomy. The authors reported that there were no correlations between imaging features and clinical improvement.…”

Lausanne checklist for safe stereotactic radiosurgery

“…Moreover, SRS using LGK ICON™ also allows for frameless radiosurgery using a mask instead of a stereotactic frame while performing single fraction or hypofractionnated radiosurgery in well-selected cases [33]. Nowadays, the clinical applications of GKRS include benign and malignant tumors of the brain and skull-base [6,8,20,34], vascular malformations[9, 21], functional [11,12,24,36] and psychiatric [25] disorders. The intimate mechanisms of action may differ according to the treated condition and the targeting strategy: tumors -apoptosis [27][28][29]; vascular malformations -vessels obliteration by thrombotic endothelial proliferation [30][31][32]; functional procedures -targeting a specific anatomical point in an anatomical structure (e.g.…”