Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response.
Gamma knife capsulotomy for intractable OCD: Neuroimage analysis of lesion size, location, and clinical response.
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DOI：
10.1038/s41398-023-02425-2
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发表时间：
2023-04-26
影响因子：
6.8
通讯作者：
Sheth, S. A.
中科院分区：
文献类型：
--
作者：
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.
强迫症（OCD）影响了2-3%的人口。三分之一的患者对常规治疗反应不佳，对于一个亚组，伽玛刀囊切开术（GKC）是一种选择。我们通过在罗德岛州普罗维登斯（巴特勒医院/罗德岛医院/布朗大学阿尔珀特医学院）和巴西<e:1>圣保罗大学（<e:1>圣保罗大学）的成熟项目检查了以前接受过GKC治疗的患者的病变特征。在T1图像上追踪26例以内囊前肢腹侧半部为靶点的GKC患者的病变，并将掩膜转化为MNI空间。采用体素级病变症状作图来评估病变位置对Y-BOCS评分的影响。建立一般线性模型，比较ALIC不同轴线上病变大小/位置与Y-BOCS评分高于或低于平均水平变化之间的关系。该样本中69%是完全缓解者（OCD改善≥35%）。病灶发生在目标区域内的任何地方与临床改善相关，但建模结果表明，病灶发生在后部（靠近前连合）和背部（靠近alic中部）与最大的Y-BOCS降低相关。Y-BOCS减少与总体病变体积之间没有关联。GKC仍然是治疗难治性强迫症的有效方法。我们的数据表明，继续瞄准冠状面ALIC的下半部分可能提供获得最佳结果所需的背腹高度，因为它将覆盖与变化相关的白质通路。进一步分析个体差异对于改善靶向性和临床结果至关重要，并有可能进一步减小病变大小，从而获得有益的结果。
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 São Paulo, Brazil (University of São 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.
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