A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive-compulsive disorder: 2-year follow-up
A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive-compulsive disorder: 2-year follow-up
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DOI：
10.1503/jpn.170188
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发表时间：
2018-09-01
影响因子：
4.3
通讯作者：
Chang, Jin Woo
中科院分区：
文献类型：
--
作者：
Kim, Se Joo;Roh, Daeyoung;Chang, Jin Woo
背景资料：最近，一种新的热毁损方法，使用磁共振引导聚焦超声（MRgFUS）被引入用于治疗神经系统疾病。然而，只有2项研究使用这种方法治疗难治性强迫症（OCD），并且随访时间较短。我们研究了使用MRgFUS对患有难治性强迫症的患者进行内囊前肢双侧热损伤的有效性和安全性，并对其进行了2年的随访。方法：11例难治性强迫症患者纳入研究。采用Yale-Brown强迫量表、临床总体印象量表（包括改善和严重程度）、汉密尔顿抑郁量表（HAM-D）和汉密尔顿焦虑量表（HAM-A）评价MRgFUS后1周和1、3、6、12和24个月的临床结局。还评估了神经心理功能、总体功能评估和不良事件。结果如下：MRgFUS后，耶鲁-布朗强迫量表评分在24个月的随访期间显著降低（基线时的平均标准差为34.4 +/- 2.3，24个月时为21.3 +/- 6.2，p < 0.001）。汉密尔顿量表的抑郁和焦虑评分从基线到24个月也显著降低（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）。总体功能评估评分显著改善（基线时为35.8 +/- 4.9，24个月时为56.0 +/- 10.3，p < 0.001），记忆商显著改善，但其他神经心理功能无变化。MRgFUS的副作用包括头痛和前庭症状，但这些都是轻微和短暂的。局限性：本研究的主要局限性是样本量小和开放标签设计。结论：使用MRgFUS对内囊前肢进行双侧热毁损可改善难治性强迫症患者的强迫、抑郁和焦虑症状，且无严重不良反应。
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.