Prospective Long-Term Follow-Up of 44 Patients Who Received Cingulotomy for Treatment-Refractory Obsessive-Compulsive Disorder

Dougherty, Darin D.; Baer, Lee; Cosgrove, G. Rees; Cassem, Edwin H.; Price, Bruce H.; Nierenberg, Andrew A.; Jenike, Michael A.; Rauch, Scott L.

doi:10.1176/appi.ajp.159.2.269

Cited by 295 publications

(165 citation statements)

References 19 publications

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“…Each site enrolled five adult patients beginning in February 2001 after IRB and FDA Investigational Device Exemption approvals were obtained at each site. Patient selection was based on the criteria developed to determine eligibility for neurosurgery for otherwise intractable OCD (Dougherty et al, 2002) and followed the guidelines of the DBS for OCD Collaborative Group (Nuttin et al, 2003a).…”

Section: Methodsmentioning

confidence: 99%

“…Therapeutic options in this group were previously limited to ablative surgery, such as anterior capsulotomy (see review by Greenberg et al, 2003) or anterior cingulotomy (Dougherty et al, 2002). Beginning with the work of Nuttin et al, small-scale controlled (Nuttin et al, 1999(Nuttin et al, , 2003bGabriels et al, 2003;Abelson et al, 2005) and open studies (Anderson and Ahmed, 2003;Aouizerate et al, 2004;Sturm et al, 2003;Aouizerate et al, 2005) have suggested that deep brain stimulation (DBS) of the internal capsule and/or the adjacent ventral striatal region may be of benefit to severely affected OCD patients who have exhausted conventional therapies.…”

Section: Introductionmentioning

confidence: 99%

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Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Greenberg

Malone

Friehs

et al. 2006

Neuropsychopharmacol

704

434

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Deep brain stimulation (DBS) of the anterior limb of the internal capsule has been shown to be beneficial in the short term for obsessive-compulsive disorder (OCD) patients who exhaust conventional therapies. Nuttin et al, who published the first DBS for OCD series, found promising results using a capsule target immediately rostral to the anterior commissure extending into adjacent ventral capsule/ventral striatum (VC/VS). Published long-term outcome data are limited to four patients. In this collaborative study, 10 adult OCD patients meeting stringent criteria for severity and treatment resistance had quadripolar stimulating leads implanted bilaterally in the VC/VS. DBS was activated openly 3 weeks later. Eight patients have been followed for at least 36 months. Group Yale-Brown Obsessive Compulsive Scale (YBOCS) scores decreased from 34.670.6 (mean7SEM) at baseline (severe) to 22.372.1 (moderate) at 36 months (po0.001). Four of eight patients had a X35% decrease in YBOCS severity at 36 months; in two patients, scores declined between 25 and 35%. Global Assessment of Functioning scores improved from 36.671.5 at baseline to 53.872.5 at 36 months (po0.001). Depression and anxiety also improved, as did self-care, independent living, and work, school, and social functioning. Surgical adverse effects included an asymptomatic hemorrhage, a single seizure, and a superficial infection. Psychiatric adverse effects included transient hypomanic symptoms, and worsened depression and OCD when DBS was interrupted by stimulator battery depletion. This open study found promising long-term effects of DBS in highly treatment-resistant OCD.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Greenberg

Malone

Friehs

et al. 2006

Neuropsychopharmacol

704

434

View full text Add to dashboard Cite

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“…7,10,14 A noninvasive approach that involves stereotactic radiosurgery is also possible, but there are risks associated with the delivery of radiation.…”

Section: Anterior Cingulotomy and Psychosurgerymentioning

confidence: 99%

Potential intracranial applications of magnetic resonance–guided focused ultrasound surgery

Monteith¹,

Sheehan²,

Medel³

et al. 2013

JNS

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Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has the potential to create a shift in the treatment paradigm of several intracranial disorders. High-resolution MRI guidance combined with an accurate method of delivering high doses of transcranial ultrasound energy to a discrete focal point has led to the exploration of noninvasive treatments for diseases traditionally treated by invasive surgical procedures. In this review, the authors examine the current intracranial applications under investigation and explore other potential uses for MRgFUS in the intracranial space based on their initial cadaveric studies. 215Abbreviations used in this paper: ICH = intracerebral hemorrhage; MRgFUS = magnetic resonance-guided focused ultrasound surgery; TCCD = transcranial color-coded duplex; TCD = transcranial Doppler; tPA = tissue plasminogen activator.

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“…26 In capsulotomy, lesions that are made in the limb of the internal capsule are thought to primarily interrupt the orbito-frontal and subgenual anterior cingulum cortex and thalamic connections. Edema or other secondary effects might also affect the frontalstriatal circuits.…”

Section: Sc and Pandasmentioning

confidence: 99%

PANDAS: current status and directions for research

2004

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The recognition of the five criteria for PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) by Swedo et al established a homogenous subgroup of children with childhood onset obsessive-compulsive disorder (OCD) and/or tic disorders. The five clinical characteristics that define the PANDAS subgroup are the presence of OCD and/or tic disorder, prepubertal age of onset, abrupt onset and relapsing-remitting symptom course, association with neurological abnormalities during exacerbations (adventitious movements or motoric hyperactivity), and a temporal association between symptom exacerbations and a Group-A beta-hemolytic streptococcal (GAS) infection. These five criteria have been used for the purpose of systematic research on the phenomenology and unique therapies for the PANDAS subgroup as well as studies of the pathophysiology of poststreptococcal OCD and tic disorders. The etiology of OCD and tics in the PANDAS subgroup is unknown, but is theorized to occur as a result of post-streptococcal autoimmunity in a manner similar to that of Sydenham's chorea. The working hypothesis for the pathophysiology begins with a GAS infection in a susceptible host that incites the production of antibodies to GAS that crossreact with the cellular components of the basal ganglia, particularly in the caudate nucleus and putamen. The obsessions, compulsions, tics, and other neuropsychiatric symptoms seen in these children are postulated to arise from an interaction of these antibodies with neurons of the basal ganglia.

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Prospective Long-Term Follow-Up of 44 Patients Who Received Cingulotomy for Treatment-Refractory Obsessive-Compulsive Disorder

Abstract: Thirty-two percent to 45% of patients previously unresponsive to medication and behavioral treatments for OCD were at least partly improved after cingulotomy. Cingulotomy remains a viable treatment option for patients with severe treatment-refractory OCD.

Cited by 295 publications

References 19 publications

Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

Potential intracranial applications of magnetic resonance–guided focused ultrasound surgery

PANDAS: current status and directions for research

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