White matter changes after Gamma Knife Capsulotomy in patients with intractable obsessive-compulsive disorder.
Anterior limb of internal capsule
Diffusion weighted imaging
Fixel based analysis
Gamma Knife
Obsessive compulsive disorder
Y-BOCS
Journal
Heliyon
ISSN: 2405-8440
Titre abrégé: Heliyon
Pays: England
ID NLM: 101672560
Informations de publication
Date de publication:
30 Jul 2024
30 Jul 2024
Historique:
received:
02
04
2024
revised:
12
07
2024
accepted:
15
07
2024
medline:
16
8
2024
pubmed:
16
8
2024
entrez:
16
8
2024
Statut:
epublish
Résumé
Anterior capsulotomy is one of the therapeutic options for refractory obsessive-compulsive disorder (OCD). Safety and efficacy of Gamma Knife Capsulotomy (GKC) have been demonstrated in the past. To characterize changes induced by GKC using a fixel-based analysis (FBA) and possible predictors of efficacy. Patients with OCD refractory to other therapies underwent bilateral GKC with 120 Gy as a maximum dose on the anterior limb of the internal capsule (ALIC). The clinical outcome was percent reduction in Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). White Matter changes were analyzed using fixel-based analysis (FBA) for fibre density (FD), fibre-bundle cross-section (FC) and the combination of the two (FDC). Seven patients underwent GKC. Median follow-up was 13 months (range 12-58 months). Mean (±SD) decrease in Y-BOCS score at last follow-up was 61 % ± 35 % with five patients considered as responders. FBA showed a symmetric FD reduction in the ALIC with extension to the anterior fronto-thalamic radiation; a reduction of FC along the superior longitudinal fasciculus (SLF) in both hemispheres with a predominance in the left one. Reductions in FDC were detected predominantly in the right hemisphere, with a similar pattern to FD reductions and associated with a positive correlation (p < 0.05) between Y-BOCS reduction and fibres passing in the ventral part. GKC is safe and efficient in reducing OCD severity in selected patients. Changes induced in white matter by GKC extend over the ALIC. Reduction of fibres passing the ventral part of the right sided ALIC correlates with better results.
Sections du résumé
Background
UNASSIGNED
Anterior capsulotomy is one of the therapeutic options for refractory obsessive-compulsive disorder (OCD). Safety and efficacy of Gamma Knife Capsulotomy (GKC) have been demonstrated in the past.
Objective
UNASSIGNED
To characterize changes induced by GKC using a fixel-based analysis (FBA) and possible predictors of efficacy.
Methods
UNASSIGNED
Patients with OCD refractory to other therapies underwent bilateral GKC with 120 Gy as a maximum dose on the anterior limb of the internal capsule (ALIC). The clinical outcome was percent reduction in Yale- Brown Obsessive-Compulsive Scale (Y-BOCS). White Matter changes were analyzed using fixel-based analysis (FBA) for fibre density (FD), fibre-bundle cross-section (FC) and the combination of the two (FDC).
Results
UNASSIGNED
Seven patients underwent GKC. Median follow-up was 13 months (range 12-58 months). Mean (±SD) decrease in Y-BOCS score at last follow-up was 61 % ± 35 % with five patients considered as responders. FBA showed a symmetric FD reduction in the ALIC with extension to the anterior fronto-thalamic radiation; a reduction of FC along the superior longitudinal fasciculus (SLF) in both hemispheres with a predominance in the left one. Reductions in FDC were detected predominantly in the right hemisphere, with a similar pattern to FD reductions and associated with a positive correlation (p < 0.05) between Y-BOCS reduction and fibres passing in the ventral part.
Conclusions
UNASSIGNED
GKC is safe and efficient in reducing OCD severity in selected patients. Changes induced in white matter by GKC extend over the ALIC. Reduction of fibres passing the ventral part of the right sided ALIC correlates with better results.
Identifiants
pubmed: 39149069
doi: 10.1016/j.heliyon.2024.e34699
pii: S2405-8440(24)10730-X
pmc: PMC11325066
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e34699Informations de copyright
© 2024 The Authors.
Déclaration de conflit d'intérêts
The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Jirsa Viktor reports financial support was provided by 10.13039/100007586Aix-Marseille University. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.