PMID- 30215566 OWN - NLM STAT- MEDLINE DCOM- 20191120 LR - 20200108 IS - 1933-0693 (Electronic) IS - 0022-3085 (Linking) VI - 131 IP - 2 DP - 2018 Sep 14 TI - Results of Gamma Knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients. PG - 376-383 LID - 2018.4.JNS171525 [pii] LID - 10.3171/2018.4.JNS171525 [doi] AB - OBJECTIVE: Obsessive-compulsive disorder (OCD) is a severe psychiatric condition. The authors present their experience with Gamma Knife radiosurgery (GKRS) in the treatment of patients with OCD resistant to any medical therapy. METHODS: Patients with severe OCD resistant to all pharmacological and psychiatric treatments who were treated with anterior GKRS capsulotomy were retrospectively reviewed. These patients were submitted to a physical, neurological, and neuropsychological examination together with structural and functional MRI before and after GKRS treatment. Strict study inclusion criteria were applied. Radiosurgical capsulotomy was performed using two 4-mm isocenters targeted at the midputaminal point of the anterior limb of the capsule. A maximal dose of 120 Gy was prescribed for each side. Clinical global changes were assessed using the Clinical Global Impression (CGI) scale, Global Assessment of Functioning (GAF) scale, EQ-5D, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI). OCD symptoms were determined by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). RESULTS: Ten patients with medically refractory OCD (5 women and 5 men) treated between 2006 and 2015 were included in this study. Median age at diagnosis was 22 years, median duration of illness at the time of radiosurgery was 14.5 years, and median age at treatment was 38.8 years. Before GKRS, the median Y-BOCS score was 34.5 with a median obsession score of 18 and compulsion score of 17. Seven (70%) of 10 patients achieved a full response at their last follow-up, 2 patients were nonresponders, and 1 patient was a partial responder. Evaluation of the Y-BOCS, BDI, STAI-Trait, STAI-State, GAF, and EQ-5D showed statistically significant improvement at the last follow-up after GKRS. Neurological examinations were normal in all patients at each visit. At last follow-up, none of the patients had experienced any significant adverse neuropsychological effects or personality changes. CONCLUSIONS: GKRS anterior capsulotomy is effective and well tolerated with a maximal dose of 120 Gy. It reduces both obsessions and compulsions, improves quality of life, and diminishes depression and anxiety. FAU - Spatola, Giorgio AU - Spatola G AD - 1Department of Neurosurgery, IRCCS Ospedale San Raffaele, Milano, Italy. AD - 8Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France. FAU - Martinez-Alvarez, Roberto AU - Martinez-Alvarez R AD - 2Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain. FAU - Martinez-Moreno, Nuria AU - Martinez-Moreno N AD - 2Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain. FAU - Rey, German AU - Rey G AD - 2Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain. FAU - Linera, Juan AU - Linera J AD - 3Department of Radiodiagnosis, Ruber International Hospital, Madrid, Spain. FAU - Rios-Lago, Marcos AU - Rios-Lago M AD - 4Department of Basic Psychology II, UNED, Madrid, Spain. FAU - Sanz, Marta AU - Sanz M AD - 5Department of Psychiatry and Neurology, Ruber International Hospital, Madrid, Spain. FAU - Gutierrez, Jorge AU - Gutierrez J AD - 2Department of Radiosurgery and Functional Neurosurgery, Ruber International Hospital, Madrid, Spain. FAU - Vidal, Pablo AU - Vidal P AD - 6Department of Psychiatry, HM Hospital de Madrid, Spain. FAU - Richieri, Raphaelle AU - Richieri R AD - 7Department of Psychiatry, Aix-Marseille University, Marseille, France; and. FAU - Regis, Jean AU - Regis J AD - 8Department of Functional Neurosurgery, Timone University Hospital, Aix-Marseille University, Marseille, France. LA - eng PT - Journal Article PL - United States TA - J Neurosurg JT - Journal of neurosurgery JID - 0253357 SB - IM MH - Adult MH - Aged MH - Female MH - Follow-Up Studies MH - Humans MH - Male MH - Middle Aged MH - Obsessive-Compulsive Disorder/*diagnostic imaging/*surgery MH - Putamen/*diagnostic imaging/*surgery MH - Radiosurgery/*methods MH - Retrospective Studies OTO - NOTNLM OT - BDI = Beck Depression Inventory OT - CGI = Clinical Global Impression OT - CGI-I = CGI-Improvement subscale OT - CGI-S = CGI-Severity subscale OT - DBS = deep brain stimulation OT - GAF = Global Assessment of Functioning OT - GKRS = Gamma Knife radiosurgery OT - Gamma Knife radiosurgery OT - OCD = obsessive-compulsive disorder OT - STAI = State-Trait Anxiety Inventory OT - STAI-S = STAI-State OT - STAI-T = STAI-Trait OT - Y-BOCS = Yale-Brown Obsessive Compulsive Scale OT - capsulotomy OT - functional neurosurgery OT - obsessive-compulsive disorder EDAT- 2018/09/15 06:00 MHDA- 2019/11/21 06:00 CRDT- 2018/09/15 06:00 PHST- 2017/06/24 00:00 [received] PHST- 2018/04/02 00:00 [accepted] PHST- 2018/09/15 06:00 [pubmed] PHST- 2019/11/21 06:00 [medline] PHST- 2018/09/15 06:00 [entrez] AID - 2018.4.JNS171525 [pii] AID - 10.3171/2018.4.JNS171525 [doi] PST - ppublish SO - J Neurosurg. 2018 Sep 14;131(2):376-383. doi: 10.3171/2018.4.JNS171525.