Steven A Rasmussen1, Georg Noren2, Benjamin D Greenberg3, Richard Marsland3, Nicole C McLaughlin3, Paul J Malloy3, Stephen P Salloway3, David R Strong4, Jane L Eisen3, Michael A Jenike4, Scott L Rauch4, Lee Baer4, Christer Lindquist5. 1. Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island. Electronic address: Steven_Rasmussen@brown.edu. 2. Department of Neurosurgery, Rhode Island Hospital, Brown University School of Medicine, Providence, Rhode Island. 3. Department of Psychiatry and Human Behavior, Butler Hospital, Brown University School of Medicine, Providence, Rhode Island. 4. Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. 5. Department of Stereotactic Neurosurgery, Cromwell Hospital, London, United Kingdom.
Abstract
BACKGROUND: Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. METHODS: Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging. RESULTS: Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state. CONCLUSIONS: Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCD patients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.
BACKGROUND: Despite the development of effective pharmacologic and cognitive behavioral treatments for obsessive-compulsive disorder (OCD), some patients continue to be treatment-refractory and severely impaired. Fiber tracts connecting orbitofrontal and dorsal anterior cingulate cortex with subcortical nuclei have been the target of neurosurgical lesions as well as deep brain stimulation in these patients. We report on the safety and efficacy of ventral gamma capsulotomy for patients with intractable OCD. METHODS: Fifty-five patients with severely disabling, treatment-refractory OCD received bilateral lesions in the ventral portion of the anterior limb of the internal capsule over a 20-year period using the Leksell Gamma Knife. The patients were prospectively followed over 3 years with psychiatric, neurologic, and neuropsychological assessments of safety and efficacy, as well as structural neuroimaging. RESULTS: Thirty-one of 55 patients (56%) had an improvement in the primary efficacy measure, the Yale-Brown Obsessive Compulsive Scale, of ≥35% over the 3-year follow-up period. Patients had significant improvements in depression, anxiety, quality of life, and global functioning. Patients tolerated the procedure well without significant acute adverse events. Five patients (9%) developed transient edema that required short courses of dexamethasone. Three patients (5%) developed cysts at long-term follow-up, 1 of whom developed radionecrosis resulting in an ongoing minimally conscious state. CONCLUSIONS: Gamma Knife ventral capsulotomy is an effective radiosurgical procedure for many treatment-refractory OCDpatients. A minority of patients developed cysts at long-term follow-up, 1 of whom had permanent neurological sequelae.
Authors: Christopher Pittenger; Brian P Brennan; Lorrin Koran; Carol A Mathews; Gerald Nestadt; Michele Pato; Katharine A Phillips; Carolyn I Rodriguez; H Blair Simpson; Petros Skapinakis; Dan J Stein; Eric A Storch Journal: Psychiatry Res Date: 2021-03-04 Impact factor: 11.225
Authors: Nicole C R McLaughlin; Peter M Lauro; Morgan T Patrick; Francesco G Pucci; Adriel Barrios-Anderson; Benjamin D Greenberg; Steven A Rasmussen; Wael F Asaad Journal: Neurosurgery Date: 2021-05-13 Impact factor: 4.654
Authors: Nicole C R McLaughlin; Darin D Dougherty; Emad Eskandar; Herbert Ward; Kelly D Foote; Donald A Malone; Andre Machado; William Wong; Mark Sedrak; Wayne Goodman; Brian H Kopell; Fuad Issa; Donald C Shields; Osama A Abulseoud; Kendall Lee; Mark A Frye; Alik S Widge; Thilo Deckersbach; Michael S Okun; Dawn Bowers; Russell M Bauer; Dana Mason; Cynthia S Kubu; Ivan Bernstein; Kyle Lapidus; David L Rosenthal; Robert L Jenkins; Cynthia Read; Paul F Malloy; Stephen Salloway; David R Strong; Richard N Jones; Steven A Rasmussen; Benjamin D Greenberg Journal: Contemp Clin Trials Commun Date: 2021-06-05