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Long-term clinical outcome of a novel bilateral capsulotomy with focused ultrasound in refractory obsessive-compulsive disorder treatment

Molecular Psychiatry volume 30, pages 1897–1905 (2025)Cite this article

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Abstract

Magnetic resonance-guided focused ultrasound (MRgFUS) capsulotomy is a promising treatment for refractory obsessive-compulsive disorder (OCD); however, long-term clinical outcome studies are lacking. We aimed to investigate the long-term efficacy and safety of MRgFUS capsulotomy in patients with refractory OCD. Ten of the eleven patients who underwent MRgFUS capsulotomy for treatment-resistant OCD between 2013 and 2014 were included in this study. Clinical outcomes were assessed after 10 years of follow-up post-MRgFUS capsulotomy using tools such as neuropsychological test, the Frontal Systems Behavior Scale (FrSBe), and a locally developed MRgFUS-patient-centered outcomes questionnaire. After 10 years of follow-up, there was a mean improvement of 52.3% in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score. Seven out of the ten participants responded fully (Y-BOCS reduction ≥35% + CGI-I 1 or 2) to the procedure, two of whom achieved remission (Y-BOCS score ≤12 and CGI-S 1 or 2). Obsessive-compulsive symptoms and overall functioning significantly reduced and improved, respectively (Y-BOCS = 20.7 after 2 years vs. 16.4 after 10 years, p = 0.012; Global Assessment of Functioning = 57.4 after 2 years vs. 69.0 after 10 years, p = 0.011). The patients experienced significantly improved frontal lobe-related functions (FrSBe Sum before 91.0 ± 17.6 vs. after 78.6 ± 17.7, p < 0.05). No adverse effects, including cases of suicide and neurological deficits, were reported. The majority of the respondents were generally satisfied with MRgFUS capsulotomy. MRgFUS capsulotomy is an effective and safe treatment option for the treatment of severe refractory OCD with sustained efficacy even after 10 years.

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Fig. 1: Individual, and mean Y-BOCS, HAM-D, HAM-A, GAF scores during the 10 years follow-up period after MRgFUS.
Fig. 2: Clinical responses of MRgFUS capsulotomy.
Fig. 3: Periodic changes of MRgFUS capsulotomy lesion size.

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Data availability

Data were available from the corresponding author upon reasonable request.

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Acknowledgements

This study was originally supported by a research grant from Insightec (1-2012-0032, Haifa, Israel, to JWC) and a National Research Foundation of Korea (NRF) grant funded by the Korean government (NRF-2021M3E5D9025022 and RS-2023-00209077 to SJK). We thank Eyal Zadicario, Itay Rachmilevitch, and other employees of InSightec for excellent assistance in the technical aspects of the procedures.

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Author notes

  1. These authors contributed equally: Kyung Won Chang, Jhin Goo Chang, Jin Woo Chang, Se Joo Kim.

Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Kyung Won Chang

  2. Department of Psychiatry, Yonsei Forest Mental Health Clinic, Seoul, Korea

    Jhin Goo Chang

  3. Department of Neurosurgery, Brain Research institute, Yonsei University College of Medicine, Seoul, Korea

    Hyun Ho Jung

  4. Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

    Chan-Hyung Kim & Se Joo Kim

  5. Department of Neurosurgery Korea University Anam Hospital, Seoul, Korea

    Jin Woo Chang

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  1. Kyung Won Chang
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Contributions

KWC Writing of the manuscript and analysis of clinical and image data, JGC Writing of the manuscript, acquisition and analysis of data, and evaluating patients, HHJ Analysis of data and revised the manuscript. C-HK Acquisition of data and revised the manuscript. JWC Revised the manuscript, conception of study, designed and directed the study, and director of MRgFUS procedures. SJK Revised the manuscript, recruited participants, collected data, evaluated patients, conception of study, designed and directed the study.

Corresponding authors

Correspondence to Jin Woo Chang or Se Joo Kim.

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The authors declare no competing interest.

Ethics approval and consent to participate

All research methods in this study was conducted in accordance with the Declaration of Helsinki and was approved by the institutional review board of the Severance Hospital (IRB No.: 1-2012-0032, 1-2015-0070, and 4-2023-0347). Written informed consent was obtained from all patients at the beginning of the study. Individual identifiable data are not included in this study.

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Chang, K.W., Chang, J.G., Jung, H.H. et al. Long-term clinical outcome of a novel bilateral capsulotomy with focused ultrasound in refractory obsessive-compulsive disorder treatment. Mol Psychiatry 30, 1897–1905 (2025). https://doi.org/10.1038/s41380-024-02799-9

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