Interstitial laser anterior capsulotomy for obsessive–compulsive disorder: lesion size and tractography correlate with outcome
| Autor: | Peter C. Warnke, Anil K. Mahavadi, Maureen Lacy, David Satzer, Jon E. Grant |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male Obsessive-Compulsive Disorder medicine.medical_specialty Internal capsule Neurosurgical Procedures Lesion Young Adult Refractory Laser Interstitial Thermal Therapy Internal Capsule Humans Medicine Anterior capsulotomy business.industry Middle Aged Magnetic Resonance Imaging Surgery Psychiatry and Mental health Diffusion Tensor Imaging Treatment Outcome Female Neurology (clinical) Disconnection Neurosurgery medicine.symptom business Tractography |
| Zdroj: | Journal of Neurology, Neurosurgery & Psychiatry. 93:317-323 |
| ISSN: | 1468-330X 0022-3050 |
| Popis: | BackgroundAnterior capsulotomy is a well-established treatment for refractory obsessive–compulsive disorder (OCD). MRI-guided laser interstitial thermal therapy (LITT) allows creation of large, sharply demarcated lesions with the safeguard of real-time imaging.ObjectiveTo characterise the outcomes of laser anterior capsulotomy, including radiographical predictors of improvement.MethodsPatients with severe OCD refractory to pharmacotherapy and cognitive–behavioural therapy underwent bilateral anterior capsulotomy via LITT. The primary outcome was per cent reduction in Yale-Brown Obsessive–Compulsive Scale (Y-BOCS) score over time. Lesion size was measured on postablation MRI. Disconnection of the anterior limb of the internal capsule (ALIC) was assessed via individual and normative tractography.ResultsEighteen patients underwent laser anterior capsulotomy. Median follow-up was 6 months (range 3–51 months). Time occupied by obsessions improved immediately (median Y-BOCS item 1 score 4–1, p=0.002). Mean (±SD) decrease in Y-BOCS score at last follow-up was 46%±32% (16±11 points, pConclusionsLaser anterior capsulotomy resulted in immediate, marked improvement in OCD symptom severity. Larger lesions permit greater disconnection of prefrontal–subcortical pathways involved in OCD. The importance of greater disconnection is presumably related to variation in ALIC structure and the complex role of the PFC in OCD. |
| Databáze: | OpenAIRE |
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