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Ventral striatal/ventral capsular Gamma capsulotomy for obsessive-compulsive disorder: a randomized controlled trial

Grant number: 08/10257-0
Support type:Scholarships in Brazil - Post-Doctorate
Effective date (Start): March 01, 2009
Effective date (End): November 30, 2011
Field of knowledge:Health Sciences - Medicine - Psychiatry
Principal researcher:Eurípedes Constantino Miguel Filho
Grantee:Antonio Carlos Lopes
Home Institution: Instituto de Psiquiatria Doutor Antonio Carlos Pacheco e Silva (IPq). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
Associated research grant:05/55628-8 - Phenotypic, genetic, immunological and neurobiological characterization of the obsessive compulsive disorder and its implications for treatment, AP.TEM

Abstract

Up to 40% of obsessive-compulsive disorder (OCD) patients do not respond to conventional therapies. For them, stereotactic neurosurgery is usually indicated. An improved radiosurgical technique was recently developed, called ventral striatal/ventral capsular (VC/VS) Gamma capsulotomy. On the other hand, there are no randomized controlled trials (RCT) assesing the efficacy and adverse events of radiosurgical procedures, including this one. The first RCT in the world is now being conducted in our center. Preliminary results with patients randomized to receive (in a double-blind method)either true or false radiosurgery suggest that this procedure is possibly efficacious and has a low profile of adverse events. However, definite conclusions can only be drawn with a larger sample size. On the other hand, efficacy and safety of smaller ventral lesions in the internal capsule are still unknown. The aims of this study are: a)to confirm, with an increased sample for the double-blind RCT, that VC/VS Gamma capsulotomy is efficacious and safe for treatment refractory OCD patients; b)to assess efficacy and safety of smaller (single-shot bilateral ventral) VC/VS Gamma capsulotomy lesions.We intend to randomize the next 10 treatment refractory OCD patients in two groups: true radiosurgery and false radiosurgery ("sham operation"). Five patients who do not accept to take part in the RCT will be offered single-shot bilateral ventral lesions. All patients will be subjected, both pre-operatively and at several post-operative time points, to a detailed clinical/psychiatric assessment, and to extensive psychiatric batteries, including diagnostic tests, OCD severity tests, depression/anxiety scales, tics scales, psychosocial impairment assessments and quality of life and family accomodation instruments. Neuropsychological and personality changes will be assessed, as well as structural and functional neuroimaging findings.

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Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
BATISTUZZO, MARCELO C.; HOEXTER, MARCELO Q.; TAUB, ANITA; GENTIL, ANDRE F.; CESAR, RAONY C. C.; JOAQUIM, MARINES A.; D'ALCANTE, CARINA CHAUBET; MCLAUGHLIN, NICOLE C.; CANTERAS, MIGUEL M.; SHAVITT, ROSELI G.; SAVAGE, CARY R.; GREENBERG, BENJAMIN D.; NOREN, GEORG; MIGUEL, EURIPEDES C.; LOPES, ANTONIO C. Visuospatial Memory Improvement after Gamma Ventral Capsulotomy in Treatment Refractory Obsessive-Compulsive Disorder Patients. NEUROPSYCHOPHARMACOLOGY, v. 40, n. 8, p. 1837-1845, JUL 2015. Web of Science Citations: 9.
HOEXTER, MARCELO Q.; DOUGHERTY, DARIN D.; SHAVITT, ROSELI G.; D'ALCANTE, CARINA C.; DURAN, FABIO L. S.; LOPES, ANTONIO C.; DINIZ, JULIANA B.; BATISTUZZO, MARCELO C.; EVANS, KARLEYTON C.; BRESSAN, RODRIGO A.; BUSATTO, GERALDO F.; MIGUEL, EURIPEDES C. Differential prefrontal gray matter correlates of treatment response to fluoxetine or cognitive-behavioral therapy in obsessive-compulsive disorder. European Neuropsychopharmacology, v. 23, n. 7, p. 569-580, JUL 2013. Web of Science Citations: 29.
HOEXTER, MARCELO QUEIROZ; DE SOUZA DURAN, FABIO LUIS; D'ALCANTE, CARINA CHAUBET; DOUGHERTY, DARIN DEAN; SHAVITT, ROSELI GEDANKE; LOPES, ANTONIO CARLOS; DINIZ, JULIANA BELO; DECKERSBACH, THILO; BATISTUZZO, MARCELO CAMARGO; BRESSAN, RODRIGO AFFONSECA; MIGUEL, EURIPEDES CONSTANTINO; BUSATTO, GERALDO FILHO. Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial. NEUROPSYCHOPHARMACOLOGY, v. 37, n. 3, p. 734-745, 2011. Web of Science Citations: 67.

Please report errors in scientific publications list by writing to: cdi@fapesp.br.