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

J Psychiatry Neurosci. 2018 Aug;43(5):327-337. doi: 10.1503/jpn.170188.

Abstract

Background: Recently, a new thermal lesioning approach using magnetic resonance-guided focused ultrasound (MRgFUS) was introduced for the treatment of neurologic disorders. However, only 2 studies have used this approach for treatment-refractory obsessive-compulsive disorder (OCD), and follow-up was short-term. We investigated the efficacy and safety of bilateral thermal lesioning of the anterior limb of the internal capsule using MRgFUS in patients with treatment-refractory OCD and followed them for 2 years.

Methods: Eleven patients with treatment-refractory OCD were included in the study. Clinical outcomes were evaluated using the Yale-Brown Obsessive Compulsive Scale, the Clinical Global Impression scale (including improvement and severity), the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A) at 1 week and 1, 3, 6, 12 and 24 months following MRgFUS. Neuropsychological functioning, Global Assessment of Functioning and adverse events were also assessed.

Results: After MRgFUS, Yale-Brown Obsessive Compulsive Scale scores decreased significantly across the 24-month follow-up period (mean ± standard deviation, 34.4 ± 2.3 at baseline v. 21.3 ± 6.2 at 24 months, p < 0.001). Scores on the Hamilton rating scales for depression and anxiety also significantly decreased from baseline to 24 months (HAM-D, 19.0 ± 5.3 v. 7.6 ± 5.3, p < 0.001; HAM-A, 22.4 ± 5.9 v. 7.9 ± 3.9, p < 0.001). Global Assessment of Functioning scores improved significantly (35.8 ± 4.9 at baseline v. 56.0 ± 10.3 at 24 months, p < 0.001) and Memory Quotient significantly improved, but other neuropsychological functions were unchanged. The side effects of MRgFUS included headache and vestibular symptoms, but these were mild and transient.

Limitations: The main limitations of this study were the small sample size and the open-label design.

Conclusion: 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Analgesics / therapeutic use
  • Antiemetics / therapeutic use
  • Anxiety / psychology
  • Depression / psychology
  • Depressive Disorder, Major / psychology
  • Dizziness / drug therapy
  • Dizziness / epidemiology
  • Drug Resistance
  • Female
  • Follow-Up Studies
  • Headache / drug therapy
  • Headache / epidemiology
  • High-Intensity Focused Ultrasound Ablation / methods*
  • Humans
  • Internal Capsule / diagnostic imaging
  • Internal Capsule / surgery*
  • Intraoperative Complications / epidemiology
  • Magnetic Resonance Imaging
  • Male
  • Nausea / drug therapy
  • Nausea / epidemiology
  • Obsessive-Compulsive Disorder / psychology
  • Obsessive-Compulsive Disorder / surgery*
  • Surgery, Computer-Assisted
  • Vomiting / drug therapy
  • Vomiting / epidemiology
  • Young Adult

Substances

  • Analgesics
  • Antiemetics