| Full text | |
| Author(s): Show less - |
Miguel, Euripedes C.
[1]
;
Lopes, Antonio C.
[1]
;
McLaughlin, Nicole C. R.
[2, 3, 4]
;
Noren, Georg
[2, 3, 4]
;
Gentil, Andre F.
[1]
;
Hamani, Clement
[5]
;
Shavitt, Roseli G.
[1]
;
Batistuzzo, Marcelo C.
[1]
;
Vattimo, Edoardo F. Q.
[1]
;
Canteras, Miguel
[6]
;
De Salles, Antonio
[7]
;
Gorgulho, Alessandra
[7]
;
Salvajoli, Joao Victor
[7]
;
Fonoff, Erich Talamoni
[8]
;
Paddick, Ian
[9]
;
Hoexter, Marcelo Q.
[1]
;
Lindquist, Christer
[10]
;
Haber, Suzanne N.
[11, 12]
;
Greenberg, Benjamin D.
[2, 3, 4]
;
Sheth, Sameer A.
[6]
Total Authors: 20
|
| Affiliation: Show less - | [1] Univ Sao Paulo, Hosp Clin HCFMUSP, Dept & Inst Psychiat, Fac Med, Sao Paulo - Brazil
[2] Brown Univ, Dept Psychiat & Human Behav, Warren Alpert Med Sch, Providence, RI 02912 - USA
[3] Brown Univ, Dept Neurosurg, Providence, RI 02912 - USA
[4] Vet Affairs Med Ctr Providence, Providence, RI - USA
[5] Univ Toronto, Div Neurosurg, Harquail Ctr Neuromodulat, Sunnybrook Hlth Sci Ctr, Toronto, ON - Canada
[6] Univ Fed Sao Paulo, Discipline Neurosurg, Sao Paulo, SP - Brazil
[7] Hosp Coracao, Sao Paulo - Brazil
[8] Univ Sao Paulo, Hosp Clin HCFMUSP, Dept Neurol, Fac Med, Sao Paulo - Brazil
[9] Natl Hosp Neurol & Neurosurg, London - England
[10] BUPA Cromwell Hosp, Gamma Knife Ctr, London - England
[11] Univ Rochester, Sch Med, Rochester, NY - USA
[12] Harvard Univ, McLean Hosp, Boston, MA 02115 - USA
Total Affiliations: 12
|
| Document type: | Review article |
| Source: | MOLECULAR PSYCHIATRY; v. 24, n. 2, p. 218-240, FEB 2019. |
| Web of Science Citations: | 11 |
| Abstract | |
For more than half a century, stereotactic neurosurgical procedures have been available to treat patients with severe, debilitating symptoms of obsessive-compulsive disorder (OCD) that have proven refractory to extensive, appropriate pharmacological, and psychological treatment. Although reliable predictors of outcome remain elusive, the establishment of narrower selection criteria for neurosurgical candidacy, together with a better understanding of the functional neuroanatomy implicated in OCD, has resulted in improved clinical efficacy for an array of ablative and non-ablative intervention techniques targeting the cingulum, internal capsule, and other limbic regions. It was against this backdrop that gamma knife capsulotomy (GKC) for OCD was developed. In this paper, we review the history of this stereotactic radiosurgical procedure, from its inception to recent advances. We perform a systematic review of the existing literature and also provide a narrative account of the evolution of the procedure, detailing how the procedure has changed over time, and has been shaped by forces of evidence and innovation. As the procedure has evolved and adverse events have decreased considerably, favorable response rates have remained attainable for approximately one-half to two-thirds of individuals treated at experienced centers. A reduction in obsessive-compulsive symptom severity may result not only from direct modulation of OCD neural pathways but also from enhanced efficacy of pharmacological and psychological therapies working in a synergistic fashion with GKC. Possible complications include frontal lobe edema and even the rare formation of delayed radionecrotic cysts. These adverse events have become much less common with new radiation dose and targeting strategies. Detailed neuropsychological assessments from recent studies suggest that cognitive function is not impaired, and in some domains may even improve following treatment. We conclude this review with discussions covering topics essential for further progress of this therapy, including suggestions for future trial design given the unique features of GKC therapy, considerations for optimizing stereotactic targeting and dose planning using biophysical models, and the use of advanced imaging techniques to understand circuitry and predict response. GKC, and in particular its modern variant, gamma ventral capsulotomy, continues to be a reliable treatment option for selected cases of otherwise highly refractory OCD. (AU) | |
| FAPESP's process: | 11/21357-9 - Research on neural circuits and biological markers involved in obsessive-compulsive disorder using behavioral paradigms of fear and anxiety |
| Grantee: | Eurípedes Constantino Miguel Filho |
| Support Opportunities: | Research Projects - Thematic Grants |
| FAPESP's process: | 14/50917-0 - INCT 2014: developmental psychiatry for children and adolescents |
| Grantee: | Eurípedes Constantino Miguel Filho |
| Support Opportunities: | Research Projects - Thematic Grants |