Gamma Knife Surgery (GKS) for the Treatment of Obsessive-Compulsive Disorder (OCD) Refractory to Pharmacological Therapy: State of the Art and Review of the Literature

Object Obsessive-compulsive disorder (OCD) is a challenging psychiatric condition associated with anxiety and ritualistic behaviors. Although medical management and psychiatric therapy are effective for many patients, severe and extreme cases may prove refractory to these approaches. The authors evaluated their experience with Gamma Knife (GK) capsulotomy in treating patients with severe OCD. Methods A retrospective review of an institutional review board–approved prospective clinical GK database was conducted for patients treated for severe OCD. All patients were evaluated preoperatively by at least one psychiatrist, and their condition was deemed refractory to pharmacological and psychiatric therapy. Results Five patients were identified. Gamma Knife surgery with the GK Perfexion unit was used to target the anterior limb of the internal capsule bilaterally. A single 4-mm isocenter was used; maximum radiation doses of 140–160 Gy were delivered. All 5 patients were preoperatively and postoperatively assessed for clinical response by using both subjective and objective metrics, including the Yale-Brown Obsessive Compulsive Scale (YBOCS); 4 of the 5 patients had postoperative radiological follow-up. The median clinical follow-up was 24 months (range 6–33 months). At the time of radiosurgery, all patients had YBOCS scores in the severe or extreme range (median 32, range 31–34). At the last follow-up, 4 (80%) of the 5 patients showed marked clinical improvement; in the remaining patient (20%), mild improvement was seen. The median YBOCS score was 13 (range 12–31) at the last follow-up. Neuroimaging studies at 6 months after GK treatment demonstrated a small area of enhancement corresponding to the site of the isocenter and some mild T2 signal changes in the internal capsule. No adverse clinical effects were noted from the radiosurgery. Conclusions For patients with severe OCD refractory to medications and psychiatric therapy, GK capsulotomy afforded clinical improvement. Further study of this approach seems warranted.

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Gamma knife ventral capsulotomy for posttraumatic brain injury obsessive-compulsive disorder

Neurology India ◽

10.4103/0028-3886.181549 ◽

2016 ◽

Vol 64 (3) ◽

pp. 552

Author(s):

Milind Deogaonkar ◽

Mayur Sharma ◽

James Young ◽

John Grecula ◽

John McGregor

Keyword(s):

Brain Injury ◽

Obsessive Compulsive Disorder ◽

Gamma Knife ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Cannabis Improves Obsessive-Compulsive Disorder—Case Report and Review of the Literature

Frontiers in Psychiatry ◽

10.3389/fpsyt.2020.00681 ◽

2020 ◽

Vol 11 ◽

Author(s):

Natalia Szejko ◽

Carolin Fremer ◽

Kirsten R. Müller-Vahl

Keyword(s):

Case Report ◽

Obsessive Compulsive Disorder ◽

Review Of The Literature ◽

Obsessive Compulsive ◽

Compulsive Disorder

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The Use of Intravenous Chlorimipramine in the Treatment of Obsessive Compulsive Disorder*

The Canadian Journal of Psychiatry ◽

10.1177/070674378402900211 ◽

1984 ◽

Vol 29 (2) ◽

pp. 135-141 ◽

Cited By ~ 20

Author(s):

Lorne B. Warneke

Keyword(s):

Obsessive Compulsive Disorder ◽

Route Of Administration ◽

Response To Therapy ◽

Intravenous Route ◽

Review Of The Literature ◽

Case Histories ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Oral Form ◽

Traditional Approaches

Obsessional disorder has always remained a difficult illness for psychiatrists to treat with response to therapy, both psychotherapy and chemotherapy, being low. A review of the traditional approaches to the treatment of obsessional disorder is done, including a brief review of the literature on intravenous chlorimipramine. Five case histories of patients with previously non-responsive obsessional disorder are summarized. All five cases were treated in hospital with a series of infusions of intravenous chlorimipramine. The drug and route of administration was extremely well tolerated with rapid and dramatic relief of obsessional symptoms as well as improvement of mood in all cases. The theoretical action of chlorimipramine is discussed as well as possible reasons why the intravenous route appears to be superior to the oral form.

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Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder

Neurosurgery ◽

10.1227/neu.0b013e3181fc5c8b ◽

2011 ◽

Vol 68 (1) ◽

pp. 28-33 ◽

Cited By ~ 50

Author(s):

Douglas. Kondziolka ◽

John C. Flickinger ◽

Robert. Hudak

Keyword(s):

Obsessive Compulsive Disorder ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Internal Capsule ◽

Severe Form ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Bilateral Lesions ◽

Anterior Capsulotomy

Abstract BACKGROUND: Obsessive compulsive disorder (OCD), in its severe form, can cause tremendous disability for affected patients. OBJECTIVE: To evaluate the results following bilateral radiosurgical anterior capsulotomy for severe medically refractory OCD. METHODS: We performed gamma knife anterior capsulotomy (GKAC) on 3 patients with extreme, medically intractable OCD. According to our protocol, all patients were evaluated by at least 2 psychiatrists who recommended surgery. The patient had to request the procedure, and had to have severe OCD according to the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patient ages were 37, 55, and 40 years, and pre-radiosurgery YBOCS scores were 34/40, 39/40, and 39/40. Bilateral lesions were created with 2 4-mm isocenters to create an oval volume in the ventral internal capsule at the putaminal midpoint. A maximum dose of 140 or 150 Gy was used. RESULTS: There was no morbidity after the procedure, and all patients returned immediately to baseline function. All patients noted significant functional improvements, and reduction in OCD behavior. Follow-up was at 55, 42, and 28 months. The first patient reduced her YBOCS score from 34 to 24. One patient with compulsive skin picking and an open wound had later healing of the chronic wound and a reduction in the YBOCS score from 39 to 8. At 28 months, the third patient is living and working independently, and her YBOCS score is 18. CONCLUSION: Within a strict protocol, gamma knife radiosurgery provided improvement of OCD behavior with no adverse effects. This technique should be evaluated further in patients with severe and disabling behavioral disorders.

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Efficacy of Gamma Knife Radiosurgery in Refractory Obsessive-Compulsive Disorder: An Indian Experience

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1740453 ◽

2022 ◽

Author(s):

Sanjeev Pattankar ◽

Milind Sankhe ◽

Kersi Chavda

Keyword(s):

Obsessive Compulsive Disorder ◽

Gamma Knife ◽

Treatment Modality ◽

Gamma Knife Radiosurgery ◽

Obsessive Compulsive ◽

Noninvasive Treatment ◽

Long Term Outcome ◽

Compulsive Disorder ◽

Anterior Capsulotomy

Abstract Background Obsessive-compulsive disorder (OCD) is a chronic debilitating psychiatric condition with adverse impact on patient's sociooccupational health. Refractoriness to pharmacotherapy and psychotherapy is not uncommon. Gamma Knife radiosurgery (GKRS) is the comprehensively used and reviewed treatment modality in refractory OCD worldwide. In India, the past two decades of increasing GKRS availability has failed to create the necessary local awareness of its usefulness in refractory OCD. Limited native literature deepens the problem. Objective To analyze our experience with GKRS in refractory OCD, and report the safety and efficacy/long-term outcome in patients using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). Materials and Methods A retrospective review of patients receiving GKRS for refractory OCD between 2000 and 2020 was carried out. Case files of the eligible (n = 9) patients were reviewed for clinical, radiotherapeutic, and outcome data. Additionally, patients were contacted via telephone to enquire about their experiences, and to obtain retroactive consent for GKRS in June 2021. Information obtained was collated, computed, and analyzed. Results Male-to-female sex ratio was 8:1. Mean age at the time of GKRS and mean duration of OCD prior to GKRS was 30.1 ± 9.4 and 10.2 ± 5.8 years, respectively. Mean baseline Y-BOCS score was 29.6 ± 4.7. Our first patient received cingulotomy, while the rest underwent anterior capsulotomy. Median margin dose (50% isodose) was 70 Gy. Also, 23.8 ± 7.7 was the mean Y-BOCS score at the last follow-up (median = 30 months). Overall, 44.4% patients showed full/partial response (≥25% reduction in Y-BOCS score) at the last follow-up. In anterior capsulotomy (eight patients), patients with moderate/severe OCD showed better response (4/5 responders) than those with extreme OCD (0/3 responders). Single case of cingulotomy resulted in no response (<25% reduction in Y-BOCS score). No adverse radiation effects were noted. Also, 55.6% patients gave retroactive consent telephonically. Conclusion GKRS is a safe and effective noninvasive treatment modality for refractory OCD. Ventral anterior capsule is the preferred target. Maximum radiation doses of 120 to 160 Gy are well tolerated. Extremely severe OCD cases fared poorer. Proper awareness about the availability and efficacy of GKRS in refractory OCD is required in India.

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