Table 4 Overview of studies involving gamma-knife capsulotomy for obsessive-compulsive disorder
From: Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder
Study | Technique | No. of patients | Diagnosis (n) | Mean time of FU (mo) | Pre-op Y-BOCS | 12 mo post-op Y-BOCS | 12 mo post-op improvement (%) | Last FU Y-BOCS | Last FU improvement (%) | Responders | Severe or permanent adverse events (n) | Response criteria | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Mean | SD | Mean | SD | Mean | SD | Mean | SD | Mean | SD | n | % | |||||||
Rylander et al. [74] | Gamma Knife capsulotomy | 9 | OCD (5); "chronic anxiety" (4) | 5.4 | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 5/9 | 55.5 | NA | Loose response criteria |
Lindquist et al. [127] | Gamma Knife capsulotomy | 17 | OCD and "anxiety neurosis" (17) | 84 (first 7 pt.) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 5/7 | 71.4 | Lethargy (1) | NA |
Kihlström et al. [63] | Gamma Knife capsulotomy | 11 | OCD (5); GAD or phobias (6) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 4/11 | 36.4 | Severe fatigue (3), signs of frontal lobe syndrome (apathy, fatigue, loss of initiative, occasional disinhibition) (2) | Loose response criteria |
Rasmussen et al. [125] | Gamma ventral capsulotomy, single and double-shots | 35 | OCD (35) | NA (min. 8 month, max. 4 years) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 1/15 (single-shot), 5/13 (second, additional shot), 10/18 (double-shot) | 6.7 (single-shot), 38.5 (second additional shot), 55.6 (double-shot) | Headache and cerebral edema (3/15 additional isocenter), asymptomatic caudate infarctions (2/15 additional isocenter), mania (1/15 additional isocenter); headachea and cerebral edema (3/20 double-shot), mania (2/20 double-shot), apathy and amotivation (1/20 double-shot) | At least 35% reduction in the Y-BOCS |
Lippitz et al. [83] | Gamma Knife capsulotomy | 10 | OCD (10) | NA | NA | NA | NA | NA | NA | NA | NA | NA | 74.6 | 42.7 | 7/10 | 70 | NA | At least 50% reduction in Y-BOCS or Brief Psychiatric Rating Scale |
Rück et al. [84] | Gamma Knife capsulotomy | 9 | OCD (9) | 139. 6 | 33.4 | 4.3 | 17 | 13.9 | 50.3 | 36.3 | 14.3 | 12.1 | 55.8 | 36.3 | 5/9 | 55.6 | Chronic brain edema (1), radiation necrosis with sequelae (1), cognitive changes (1), apathy (2), urinary incontinence (1), seizures (1), sexual disinhibition (1) | At least 35% reduction in the Y-BOCS |
Lopes et al. [69] | Gamma ventral capsulotomy, double-shot | 5 | OCD (5) | 48 | 32.2 | 1.48 | 20.2 | 10.4 | 38 | 31.1 | 20.6 | 12.3 | 36.4 | 37.9 | 3/5 | 60 | Weight changes (4) | At least 35% reduction in the Y-BOCS + CGI scores "much iimproved" or "very much improved" |
Kondziolka et al. [78] | Gamma ventral capsulotomy, double-shot | 3 | OCD (2); skin-picking disorder (1) | 41.6 | 37.3 | 2.9 | NA | NA | NA | NA | 16.3 | 8.6 | 55.1 | 26.3 | 2/3 | 66.7 | NA | NA |
Rasmussen et al. [76] | Gamma ventral capsulotomy, single and double-shots | 55 | OCD (55) | NA (max. 20 years) | NA | NA | NA | NA | NA | NA | NA | NA | NA | NA | 1/15 (single-shot), 5/13 (second, additional shot), 13/22 (double-shot) | 6.7 (single-shot), 38.5 (second additional shot), 59.1 (double-shot) | Asymptomatic brain cysts (2), symptomatic brain cyst (1, with headache, dizziness, and visual changes, requiring drainage), headaches and cerebral edema (10), apathy and amotivation (1) | At least 35% reduction in the Y-BOCS |
Sheehan et al. [79] | Gamma ventral capsulotomy, single-shot | 5 | OCD (5) | 22.2 | 32.4 | 1.5 | NA | NA | NA | NA | 16.2 | 8.3 | 50.5 | 23.3 | 4/5 | 80 | None described | NA |
Lopes et al. [25] | Gamma ventral capsulotomy, double-shot | 16 | OCD (16) | 34.8 (Sham group) | 4 | 31.9 (Sham group) | 4.1 | 7.4 | 13.9 | NA (Sham Group) | NA | NA (Sham Group) | NA | 0/8 (12 month) | 0 | Increased appetite and weight (4) (Sham Group) | At least 35% reduction in the Y-BOCS + CGI scores "much iimproved" or "very much improved" | |
54.5 (Active group) | 32.5 (Active group) | 0.7 | 20.9 | 11 | 36.9 | 31.7 | 17.8 | 10 | 46.8 | 26 | 2/8 (12 month); 5/8 (last FU) | 25 (12 month); 62.5 (last FU) | Manic episode (2), delirium + perseverations for one week (1), increased appetite and weight (6), memory deficits for 10 months (1), asymptomatic brain cyst (1), substance abuse (1) (all operated patients) | |||||
55.2 (all operated patients) | 33.1 (all operated patients) | 3.3 | 21.8 | 12.6 | 34.9 | 35.5 | 17.3 | 13.1 | 51.4 | 33.5 | 7/12 (last FU, all operated patients) | 58.3 | ||||||
Peker et al. [126] | Gamma ventral capsulotomy, single and double-shots | 10 | OCD (10) | 9 (median) | 38 (median) | NA | NA | NA | NA | NA | 16 (Median) | NA | NA | NA | 7 | 70 | None described | NA |
Rasmussen et al. [77] | Gamma ventral capsulotomy, single and double-shots | 55 | OCD (55) | 36 | 33.3 (single-shot repeated, 15 pt) | 4.8 | 30.7 (single-shot repeated, 15 pt) | 7.6 | 17.8 (single-shot staged) | NA | 19.3 (single-shot repeated, 15 pt) | 11.3 | 40 (single-shot staged) | NA | 1/15 (single-shot), 5/13 (single-shot repeated) | 6.7 (single-shot), 38.5 (second additional shot) | Headaches (with transient edema in 5 pt), nausea, vomiting, radionecrosis (1), mania (3), insomnia, anxiety, altered mood, complaints of poor memory/concentration, lethargy, asymptomatic caudate infarcts (6), asymptomatic brain cyst (2), symptomatic brain cyst (1 – with headache, dizziness, visual changes, requiring neurosurgery) | At least 35% reduction in the Y-BOCS |
34.2 (double-shot, 40 pt) | 3.2 | 20.3 (double-shot, 35 pt) | 7.3 | 40.4 (double-shot) | NA | 16.8 (double-shot, 32 pt) | 8.3 | 52.7 (double-shot) | NA | 10/18 (double-shot) | 55.6 (double-shot) | |||||||
