Visuospatial Memory Improvement after Gamma Ventral Capsulotomy in Treatment Refractory Obsessive-Compulsive Disorder Patients
Visuospatial Memory Improvement after Gamma Ventral Capsulotomy in Treatment Refractory Obsessive-Compulsive Disorder Patients
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DOI：
10.1038/npp.2015.33
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发表时间：
2015-07-01
影响因子：
7.6
通讯作者：
Lopes, Antonio C.
中科院分区：
文献类型：
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作者：
Batistuzzo, Marcelo C.;Hoexter, Marcelo Q.;Lopes, Antonio C.
伽玛腹侧囊膜切开术(GVC)旨在最大限度减少副作用，同时保持传统热凝技术治疗难治性强迫症(OCD)的疗效。基于先前的研究，神经心理学结果尚不清楚，因此，我们调查了GVC对认知和运动能力的影响。采用随机双盲对照试验，将16例难治性强迫症患者分为积极治疗组(n=8)和对照组(n=8)。在基线和手术后一年进行综合神经心理学评估，包括智力功能、注意力、语言和视觉空间学习和记忆、视觉空间知觉、抑制控制、认知灵活性和运动功能。二次分析包括所有手术患者：8名来自活动组，4名来自假手术组，他们在失明后接受手术，以及来自先前开放先导研究的5名患者(n=5)，总计17名患者。在RCT中，活动组的视觉空间记忆成绩在GVC后显著改善(p=0.008)，而在假手术组则保持稳定。考虑到所有患者都接受了手术，经过一年的随访，认知或运动功能没有下降。经过1年的随访，我们的初步结果表明，GVC不仅在神经心理功能方面是一种安全的程序，而且实际上可以改善某些神经心理领域，特别是VSM的表现，在治疗难治性强迫症患者中。
Gamma ventral capsulotomy (GVC) radiosurgery is intended to minimize side effects while maintaining the efficacy of traditional thermocoagulation techniques for the treatment of refractory obsessive-compulsive disorder (OCD). Neuropsychological outcomes are not clear based on previous studies and, therefore, we investigated the effects of GVC on cognitive and motor performance. A double-blind, randomized controlled trial (RCT) was conducted with 16 refractory OCD patients allocated to active treatment (n = 8) and sham (n = 8) groups. A comprehensive neuropsychological evaluation including intellectual functioning, attention, verbal and visuospatial learning and memory, visuospatial perception, inhibitory control, cognitive flexibility, and motor functioning was applied at baseline and one year after the procedure. Secondary analysis included all operated patients: eight from the active group, four from the sham group who were submitted to surgery after blind was broken, and five patients from a previous open pilot study (n = 5), totaling 17 patients. In the RCT, visuospatial memory (VSM) performance significantly improved in the active group after GVC (p = 0.008), and remained stable in the sham group. Considering all patients operated, there was no decline in cognitive or motor functioning after one year of follow-up. Our initial results after 1 year of follow-up suggests that GVC not only is a safe procedure in terms of neuropsychological functioning but in fact may actually improve certain neuropsychological domains, particularly VSM performance, in treatment refractory OCD patients.