Renaissance for anterior capsulotomy for obsessive–compulsive disorder?

2021 ◽  
pp. jnnp-2021-328121
Author(s):  
Marwan Hariz
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy

Unilateral right anterior capsulotomy for refractory major depression with comorbid obsessive–compulsive disorder

Neurocase ◽  
2011 ◽  
Vol 17 (6) ◽  
pp. 491-500 ◽  
Author(s):  
Alonso R. Riestra ◽  
Jaime Aguilar ◽  
Gerardo Zambito ◽  
Gabriela Galindo y Villa ◽  
Fernando Barrios ◽  
...  
Keyword(s):  
Major Depression ◽  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy

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 Anterior capsulotomy for obsessive-compulsive disorder: a review of old and new literature

2020 ◽  
Vol 133 (5) ◽  
pp. 1595-1604 ◽  
Author(s):  
Joshua Pepper ◽  
Ludvic Zrinzo ◽  
Marwan Hariz
Keyword(s):  
Clinical Response ◽  
Obsessive Compulsive Disorder ◽  
Clinical Effectiveness ◽  
Multidisciplinary Teams ◽  
Neurosurgical Procedures ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
New Literature ◽  
Anterior Capsulotomy ◽  
Deep Brain

Over the last two decades, deep brain stimulation (DBS) has gained popularity as a treatment of severe and medically refractory obsessive-compulsive disorder (OCD), often using brain targets informed by historical lesional neurosurgical procedures. Paradoxically, the use of DBS in OCD has led some multidisciplinary teams to revisit the use of lesional procedures, especially anterior capsulotomy (AC), although significant aversion still exists toward the use of lesional neurosurgery for psychiatric disorders. This paper aims to review all literature on the use of AC for OCD to examine its effectiveness and safety profile.All publications on AC for OCD were searched. In total 512 patients were identified in 25 publications spanning 1961–2018. In papers where a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was available, 73% of patients had a clinical response (i.e., > 35% improvement in Y-BOCS score) and 24% patients went into remission (Y-BOCS score < 8). In the older publications, published when the Y-BOCS was not yet available, 90% of patients were deemed to have had a significant clinical response and 39% of patients were considered symptom free. The rate of serious complications was low.In summary, AC is a safe, well-tolerated, and efficacious therapy. Its underuse is likely a result of historical prejudice rather than lack of clinical effectiveness.

Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: long-term follow-up

2013 ◽  
Vol 84 (11) ◽  
pp. 1208-1213 ◽  
Author(s):  
Myreille D'Astous ◽  
Sylvine Cottin ◽  
Martin Roy ◽  
Claude Picard ◽  
Léo Cantin
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Long Term Follow Up ◽  
Anterior Capsulotomy

Interstitial laser anterior capsulotomy for obsessive–compulsive disorder: lesion size and tractography correlate with outcome

2021 ◽  
pp. jnnp-2021-327730
Author(s):  
David Satzer ◽  
Anil Mahavadi ◽  
Maureen Lacy ◽  
Jon E Grant ◽  
Peter Warnke
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Internal Capsule ◽  
Lesion Size ◽  
Behavioural Therapy ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Ablation Volume ◽  
Cognitive Behavioural ◽  
Anterior Capsulotomy

BackgroundAnterior capsulotomy is a well-established treatment for refractory obsessive–compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging.ObjectiveTo characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement.MethodsPatients with severe OCD refractory to pharmacotherapy and cognitive–behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography.ResultsEighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3–51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4–1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, p<0.0001). Sixty-one per cent of patients were responders. Seven patients (39%) exhibited transient postoperative apathy. One patient had an asymptomatic intracerebral haemorrhage. Reduction in Y-BOCS score was positively associated with ablation volume (p=0.006). Individual tractography demonstrated durable ALIC disconnection. Normative tractography revealed a dorsal–ventral gradient, with disconnection of orbitofrontal streamlines most strongly associated with a positive response (p<0.0001).ConclusionsLaser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal–subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD.

Successful Anterior Capsulotomy in Comorbid Anorexia Nervosa and Obsessive-Compulsive Disorder: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 69 (3) ◽  
pp. E745-E751 ◽  
Author(s):  
Johan Barbier ◽  
Loes Gabriëls ◽  
Koen van Laere ◽  
Bart Nuttin
Keyword(s):  
Anorexia Nervosa ◽  
Case Report ◽  
Obsessive Compulsive Disorder ◽  
Therapeutic Option ◽  
Controlled Study ◽  
Obsessive Compulsive ◽  
Eating Pattern ◽  
Compulsive Disorder ◽  
Anterior Capsulotomy

Abstract BACKGROUND AND IMPORTANCE: State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD. CLINICAL PRESENTATION: A 38-year-old woman with life-threatening, chronic, treatment-refractory AN and OCD underwent anterior capsulotomy. Psychiatric and neuropsychological evaluations at baseline and at follow-up document the severity and progress of the case. Bilateral anterior capsulotomy resulted in normalization of eating pattern and weight and a significant decrease of food-related and overall obsessive-compulsive symptoms. Psychiatric evaluations and exposure to food cues confirmed the clinical improvement that was evident immediately after surgery and sustained at 3-month follow-up. CONCLUSION: This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.

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