J Psychiatry Neurosci 2018;43(5):327-337
Se Joo Kim, MD, PhD; Daeyoung Roh, MD, PhD; Hyun Ho Jung, MD, PhD; Won Seok Chang, MD, PhD; Chan-Hyung Kim, MD, PhD; Jin Woo Chang, MD, PhD
Background: Recently, a new thermal lesioning approach using magnetic resonance–guided focused ultrasound (MRgFUS) was introduced for the treatment of neurologic disorders. However, only 2 studies have used this approach for treatment-refractory obsessive–compulsive disorder (OCD), and follow-up was short-term. We investigated the efficacy and safety of bilateral thermal lesioning of the anterior limb of the internal capsule using MRgFUS in patients with treatment-refractory OCD and followed them for 2 years.
Methods: Eleven patients with treatment-refractory OCD were included in the study. Clinical outcomes were evaluated using the Yale–Brown Obsessive Compulsive Scale, the Clinical Global Impression scale (including improvement and severity), the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A) at 1 week and 1, 3, 6, 12 and 24 months following MRgFUS. Neuropsychological functioning, Global Assessment of Functioning and adverse events were also assessed.
Results: After MRgFUS, Yale–Brown Obsessive Compulsive Scale scores decreased significantly across the 24-month follow-up period (mean ± standard deviation, 34.4 ± 2.3 at baseline v. 21.3 ± 6.2 at 24 months, p < 0.001). Scores on the Hamilton rating scales for depression and anxiety also significantly decreased from baseline to 24 months (HAM-D, 19.0 ± 5.3 v. 7.6 ± 5.3, p < 0.001; HAM-A, 22.4 ± 5.9 v. 7.9 ± 3.9, p < 0.001). Global Assessment of Functioning scores improved significantly (35.8 ± 4.9 at baseline v. 56.0 ± 10.3 at 24 months, p < 0.001) and Memory Quotient significantly improved, but other neuropsychological functions were unchanged. The side effects of MRgFUS included headache and vestibular symptoms, but these were mild and transient.
Limitations: The main limitations of this study were the small sample size and the open-label design.
Conclusion: Bilateral thermal lesioning of the anterior limb of the internal capsule using MRgFUS may improve obsessive–compulsive, depressive and anxiety symptoms in patients with treatment-refractory OCD, without serious adverse effects.
Submitted Sept. 20, 2017; Revised Dec. 2, 2017; Revised Jan. 3, 2018; Accepted Jan. 4, 2018; Published online first May 2, 2018
Acknowledgments: The authors thank Eyal Zadicario, Itay Rachmilevitch and other employees of InSightec for their excellent technical assistance.
Affiliations: From the Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, South Korea (Se Joo Kim, Chan-Hyung Kim); the Department of Neurosurgery and Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea (Hyun Ho Jung, Won Seok Chang, Jin Woo Chang); and the Department of Psychiatry, Hallym University College of Medicine Clinical Imaging Research Centre, Chunchon, Gangwon, South Korea (Daeyoung Roh).
Funding: This study was supported by a faculty research grant from Yonsei University College of Medicine (6-2009-0063, Seoul, South Korea) and Insightec (1-2012-0032, Haifa, Israel). The sponsors had no role in the design or conduct of the study; in the collection, management, analysis or interpretation of the data; or in the preparation, review or approval of the manuscript.
Competing interests: None declared.
Contributors: S. Kim, C.-H. Kim and J. Chang designed the study. All authors acquired the data, which S. Kim and H. Jung analyzed. S. Kim wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.
Correspondence to: J.W. Chang, Department of Neurosurgery and Brain Research Institute, Yonsei University, College of Medicine (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea; firstname.lastname@example.org; C-H Kim, Department of Psychiatry and Institute of Behavioural Science in Medicine, Yonsei University, Yonsei University, College of Medicine (03722) 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Korea; email@example.com