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.
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).
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.
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.
BrownLTMikellCBYoungermanBEZhangYMcKhannGMIIShethSA: Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg124:77–892016
CalvocoressiL, LibmanD, VegsoSJ, McDougleCJ, PriceLH: Global functioning of inpatients with obsessive-compulsive disorder, schizophrenia, and major depression. 49:379–381, 1998952580110.1176/ps.49.3.379)| false
KihlströmL, HindmarshT, LaxI, LippitzB, MindusP, LindquistC: Radiosurgical lesions in the normal human brain 17 years after gamma knife capsulotomy. 41:396–402, 199710.1097/00006123-199708000-000119257307)| false
LippitzBEMindusPMeyersonBAKihlströmLLindquistC: Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery44:452–4601999
LippitzBE, MindusP, MeyersonBA, KihlströmL, LindquistC: Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. 44:452–460, 19991006958110.1097/00006123-199903000-00005)| false
LopesAC, de MathisME, CanterasMM, SalvajoliJV, Del PortoJA, MiguelEC: [Update on neurosurgical treatment for obsessive compulsive disorder.]26:62–66, 2004(Portuguese)10.1590/S1516-44462004000100015)| false
LopesACGreenbergBDCanterasMMBatistuzzoMCHoexterMQGentilAF: Gamma ventral capsulotomy for obsessive-compulsive disorder: a randomized clinical trial. JAMA Psychiatry71:1066–10762014(Retracted and replaced in JAMA Psychiatry 72:1258 2015)
MindusPBergströmKLevanderSENorénGHindmarshTThuomasKA: Magnetic resonance images related to clinical outcome after psychosurgical intervention in severe anxiety disorder. J Neurol Neurosurg Psychiatry50:1288–12931987
MindusP, BergströmK, LevanderSE, NorénG, HindmarshT, ThuomasKA: Magnetic resonance images related to clinical outcome after psychosurgical intervention in severe anxiety disorder. 50:1288–1293, 198710.1136/jnnp.50.10.12883681307)| false
NymanH, AndréewitchS, LundbäckE, MindusP: Executive and cognitive functions in patients with extreme obsessive-compulsive disorder treated by capsulotomy. 8:91–98, 200110.1207/S15324826AN0802_311515245)| false
RauchSL, DoughertyDD, MaloneD, RezaiA, FriehsG, FischmanAJ, : A functional neuroimaging investigation of deep brain stimulation in patients with obsessive-compulsive disorder. 104:558–565, 200610.3171/jns.2006.104.4.55816619660)| false