22 Stereotactic radiosurgery (SRS)for obsessive-compulsive disorder (OCD)Obsessive-compulsive disorder (OCD)Gamma Knife Radiosurgery for Obsessive–Compulsive Disorder

2016 ◽  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

scholarly journals Results Following Gamma Knife Radiosurgical Anterior Capsulotomies for Obsessive Compulsive Disorder

Neurosurgery ◽  
2011 ◽  
Vol 68 (1) ◽  
pp. 28-33 ◽  
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.

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

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.

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

2019 ◽  
Vol 131 (2) ◽  
pp. 376-383 ◽  
Author(s):  
Giorgio Spatola ◽  
Roberto Martinez-Alvarez ◽  
Nuria Martínez-Moreno ◽  
German Rey ◽  
Juan Linera ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Global Changes ◽  
Maximal Dose ◽  
Obsessive Compulsive ◽  
Partial Responder ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy

OBJECTIVEObsessive-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.METHODSPatients 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).RESULTSTen 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.CONCLUSIONSGKRS 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.

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

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

Gamma Knife surgery anterior capsulotomy for severe and refractory obsessive-compulsive disorder

2013 ◽  
Vol 119 (5) ◽  
pp. 1112-1118 ◽  
Author(s):  
Jason P. Sheehan ◽  
Gregory Patterson ◽  
David Schlesinger ◽  
Zhiyuan Xu
Keyword(s):  
Clinical Improvement ◽  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Internal Capsule ◽  
Gamma Knife Surgery ◽  
Clinical Effects ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Institutional Review

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.

O13. Delayed Treatment and Co-Occurring Psychiatric Illness Predict Response to Gamma Knife Capsulotomy for Obsessive Compulsive Disorder

2018 ◽  
Vol 83 (9) ◽  
pp. S113
Author(s):  
Adriel Barrios-Anderson ◽  
Nicole McLaughlin ◽  
Richard Marsland ◽  
Georg Noren ◽  
Wael Asaad ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Gamma Knife ◽  
Psychiatric Illness ◽  
Obsessive Compulsive ◽  
Delayed Treatment ◽  
Compulsive Disorder

scholarly journals The impact of cobalt-60 source age on biologically effective dose in high-dose functional Gamma Knife radiosurgery

2016 ◽  
Vol 125 (Supplement_1) ◽  
pp. 154-159 ◽  
Author(s):  
Benjamin H. Kann ◽  
James B. Yu ◽  
John M. Stahl ◽  
James E. Bond ◽  
Christopher Loiselle ◽  
...  
Keyword(s):  
Effective Dose ◽  
Dose Rate ◽  
Gamma Knife ◽  
Treatment Time ◽  
Gamma Knife Radiosurgery ◽  
High Dose ◽  
Biologically Effective Dose ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Dose Rates

OBJECTIVEFunctional Gamma Knife radiosurgery (GKRS) procedures have been increasingly used for treating patients with tremor, trigeminal neuralgia (TN), and refractory obsessive-compulsive disorder. Although its rates of toxicity are low, GKRS has been associated with some, if low, risks for serious sequelae, including hemiparesis and even death. Anecdotal reports have suggested that even with a standardized prescription dose, rates of functional GKRS toxicity increase after replacement of an old cobalt-60 source with a new source. Dose rate changes over the course of the useful lifespan of cobalt-60 are not routinely considered in the study of patients treated with functional GKRS, but these changes may be associated with significant variation in the biologically effective dose (BED) delivered to neural tissue.METHODSThe authors constructed a linear-quadratic model of BED in functional GKRS with a dose-protraction factor to correct for intrafraction DNA-damage repair and used standard single-fraction doses for trigeminal nerve ablation for TN (85 Gy), thalamotomy for tremor (130 Gy), and capsulotomy for obsessive-compulsive disorder (180 Gy). Dose rate and treatment time for functional GKRS involving 4-mm collimators were derived from calibrations in the authors' department and from the cobalt-60 decay rate. Biologically plausible values for the ratio for radiosensitivity to fraction size (α/β) and double-strand break (DSB) DNA repair halftimes (τ) were estimated from published experimental data. The biphasic characteristics of DSB repair in normal tissue were accounted for in deriving an effective τ1 halftime (fast repair) and τ2 halftime (slow repair). A sensitivity analysis was performed with a range of plausible parameter values.RESULTSAfter replacement of the cobalt-60 source, the functional GKRS dose rate rose from 1.48 to 2.99 Gy/min, treatment time fell, and estimated BED increased. Assuming the most biologically plausible parameters, source replacement resulted in an immediate relative BED increase of 11.7% for GKRS-based TN management with 85 Gy, 15.6% for thalamotomy with 130 Gy, and 18.6% for capsulotomy with 180 Gy. Over the course of the 63-month lifespan of the cobalt-60 source, BED decreased annually by 2.2% for TN management, 3.0% for thalamotomy, and 3.5% for capsulotomy.CONCLUSIONSUse of a new cobalt-60 source after replacement of an old source substantially increases the predicted BED for functional GKRS treatments for the same physical dose prescription. Source age, dose rate, and treatment time should be considered in the study of outcomes after high-dose functional GKRS treatments. Animal and clinical studies are needed to determine how this potential change in BED contributes to GKRS toxicity and whether technical adjustments should be made to reduce dose rates or prescription doses with newer cobalt-60 sources.

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