Gamma Ventral Capsulotomy For Refractory Obsessive-compulsive Disorder: Preliminary Findings Of A Double-blind, Randomized Controlled Trial

Carlos Antonio Lopes1, Douglas G Castro2, Miguel M Canteras2, Marcelo Batistuzzo1, Anita Taub1, Carina C DAlcante1, Benjamin D Greenberg3, Georg Norén4, Eurípedes C Miguel1

1Department of Psychiatry 2 Institute of Neurological Radiosurgery 3 Department of Psychiatry and Human Behavior 4 Department of Clinical Neurosciences - Neurosurgery

Keywords: obsessive-compulsive disorder, radiosurgery, gamma knife, outcome, technique

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     Up to 40 % of Obsessive-Compulsive Disorder (OCD) patients remain refractory to conventional treatments. For them, an improved, Gamma Knife radiosurgery (Gamma ventral capsulotomy - GVC) was recently developed.
     We report the results from a pilot study with this technique, as well as from the first double-blind, randomized controlled trial (DB-RCT) of its kind.
     Twenty one refractory OCD patients were selected. The first five patients were included in a pilot study. The other 16 subjects randomly received either active (8 patients) or “sham” (7 patients) radiosurgery, as a DB-RCT. One patient remains under blind condition.
     Double-shot, 4 mm collimator lesions were produced at the ventral portions of the anterior limb of the internal capsule. Psychopathological, clinical, and neuropsychological assessments and magnetic resonance scans were provided pre and post-operatively.
     One to five years of follow-up assessments are available. Three out of five patients (60%) from the pilot study and three out of eight patients (37.5%) from the blind active group became responders. As a whole, six out of thirteen (46 %) patients who received active radiosurgery responded, while no patients of the sham group responded, for 12 months of blind follow-up. Statistically significant differences between active and sham groups were observed for OCD symptoms scores (non-parametric analysis of variance, QW=6.760, 1 d.f.., p=0.0093). Mania, delirium, episodic headaches, dizziness, nausea were few times observed. One patient presented a cyst and a floating course of cognitive changes. No other adverse neuropsychological or personality changes were observed.
     This is a retrospective study.
     Preliminary findings indicate that GVC for OCD shows some efficacy.
     There were relatively few adverse effects.


Project Roles:

C. Lopes (), D. Castro (), M. Canteras (), M. Batistuzzo (), A. Taub (), C. DAlcante (), B. Greenberg (), G. Norén (), E. Miguel ()