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

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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.

ABBREVIATIONS BDI = Beck Depression Inventory; CGI = Clinical Global Impression; CGI-I = CGI-Improvement subscale; CGI-S = CGI-Severity subscale; DBS = deep brain stimulation; GAF = Global Assessment of Functioning; GKRS = Gamma Knife radiosurgery; OCD = obsessive-compulsive disorder; STAI = State-Trait Anxiety Inventory; STAI-S = STAI-State; STAI-T = STAI-Trait; Y-BOCS = Yale–Brown Obsessive Compulsive Scale.

Article Information

Correspondence Roberto Martinez: Ruber International Hospital, Madrid, Spain. rob.martinez@telefonica.net.

INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.4.JNS171525.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Axial (A) and coronal (B) T2-weighted images, and T1-weighted sagittal image (C), showing the prescription isodose (yellow line) and 12-Gy isodose (green line). Figure is available in color online only.

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    Line graph showing Y-BOCS changes for each patient and aggregated mean ± SEM. Figure is available in color online only.

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