Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response

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McLaughlin, N. C. R. ; Magnotti, J. F. ; Banks, G. P. ; Nanda, P. ; Hoexter, M. Q. ; Lopes, A. C. ; Batistuzzo, M. C. ; Asaad, W. F. ; Stewart, C. ; Paulo, D. ; Noren, G. ; Greenberg, B. D. ; Malloy, P. ; Salloway, S. ; Correia, S. ; Pathak, Y. ; Sheehan, J. ; Marsland, R. ; Gorgulho, A. ; De Salles, A. ; Miguel, E. C. ; Rasmussen, S. A. ; Sheth, S. A.

• Tipo de documento: Artigo Científico
• Fonte: TRANSLATIONAL PSYCHIATRY; v. 13, n. 1, p. 8-pg., 2023-04-26.

Resumo

Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and Sao Paulo, Brazil (University of Sao Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (>= 35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes. (AU)

• Processo FAPESP: 14/50917-0 - INCT 2014: psiquiatria do desenvolvimento para crianças e adolescentes
• Beneficiário: Eurípedes Constantino Miguel Filho
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 11/21357-9 - Investigação de circuitos neuronais e marcadores biológicos envolvidos no transtorno obsessivo-compulsivo por meio de paradigmas comportamentais de medo e ansiedade
• Beneficiário: Eurípedes Constantino Miguel Filho
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 13/16864-4 - Capsulotomia ventral por raios gama com lesões únicas bilaterais e estimulação encefálica profunda no TOC: avaliação da eficácia, eventos adversos e alterações no funcionamento cerebral
• Beneficiário: Marcelo Queiroz Hoexter
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado