Bilateral thermal capsulotomy with magnetic resonance‐guided focused ultrasound for patients with treatment‐resistant depression: A proof‐of‐concept study

Chang, Jhin-Goo; Jung, Hyun Ho; Kim, Se Joo; Chang, Won Seok; Jung, Na Young; Kim, Chan‐Hyung; Chang, Jin Woo

doi:10.1111/bdi.12964

Cited by 15 publications

(8 citation statements)

References 5 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Korean group ( n = 4) reported a 100% responder rate with no permanent neurological, neuropsychological, or psychobehavioral complications. Their capsulotomy height was 10 mm bilaterally [69]. Like the Vancouver group, they also noted the tristolytic effect.…”

Section: Resultsmentioning

confidence: 99%

“…The initial results have been mixed. Technical challenges need to be overcome, but what is becoming clearer is that effective capsulotomies must ventrally sited and of a minimum length in the ALIC (6–11 mm) but not too long (>15 mm, see Table 1 in Ruck et al [49]) to avoid impinging upon the dorsal associative pathway [49, 68, 69].…”

Section: Discussionmentioning

confidence: 99%

“…We have found two studies from two centers reporting on MRgFUS ablative capsulotomy for refractory TRD. One (Korean group) of the two studies reported on 4 cases [69], and the other study (Toronto group) reported on 6 MDD cases [70]. Davidson et al [70][71][72] have published several papers since 2020 with overlapping patient samples.…”

Section: Post Hoc Analysismentioning

confidence: 99%

See 2 more Smart Citations

Ablation Surgeries for Treatment-Resistant Depression: A Meta-Analysis and Systematic Review of Reported Case Series

Hurwitz

Honey

Sepehry

2022

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

Background and Objectives: Ablative lesion procedures remain as the last option in treatment of refractory depression. Contemporary ablative psychosurgeries involve producing lesions in the anterior limb of the internal capsule (bilateral anterior capsulotomy – BAC), the supragenual anterior cingulate gyrus and cingulum (bilateral anterior cingulotomy – BACING), and subgenual anterior cingulate gyrus and subcortical orbitofrontal white matter (bilateral subcaudate tractotomy – BST). A combination of BACING and BST is known as limbic leukotomy (bilateral limbic leukotomy – BLL). All procedures claim some success, but cohorts are small, depression assessment instruments differ, and inclusion and outcome criteria and follow-up duration vary. In some cohorts, more than one type of surgery was performed in several patients, further confounding interpreting the available data. Current evidence is equivocal on which surgical target works best. Method and Aim: This systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard on published cohorts was conducted to review and identify which is the best standalone ablative procedure for treatment-resistant depression (TRD) based on response rate (event rate) and adverse-effect profile using the Comprehensive Meta-Analysis software. Results and Conclusion: As a standalone neurosurgical procedure, we found that BAC appears to be the most effective and safest of all the ablative targets for TRD. A major limitation of this conclusion is the paucity of published case series where sample sizes are small and all are open label.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Ablation Surgeries for Treatment-Resistant Depression: A Meta-Analysis and Systematic Review of Reported Case Series

Hurwitz

Honey

Sepehry

2022

Stereotact Funct Neurosurg

View full text Add to dashboard Cite

show abstract

“…These methods are “incisionless” and use gamma radiation or ultrasound (respectively) to create a lesion at the target point. Results of their use to perform ACAPS or SCT in patients with MDD are encouraging but are limited to case reports and one small phase I trial [ 37 , 38 ]. However, these technologies may come to be seen as more acceptable by some patients and psychiatrists.…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

(1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literature review and meta-analysis on SRA for MDD was carried out. Patient-level data were extracted from articles reporting validated depression measures (Beck Depression Inventory (BDI), Montgomery–Åsberg Depression Rating Scale (MADRS)), pre- and at least six months post surgery. To accommodate different outcome measures, the standardised mean difference (SMD) between both scores was used as the principal effect size. Data were synthesised using a random-effects model. (3) Results: Five distinct studies were identified, comprising 116 patients (64 included in meta-analysis). Effect size comparing post- vs. pre-operative scores was 1.66 (CI 1.25–2.07). Anterior cingulotomy (two studies, n = 22) and anterior capsulotomy (three studies, n = 42) showed similar effect sizes: 1.51 (CI 0.82–2.20) vs. 1.74 (CI 1.23–2.26). Multiple procedures were performed in 30 of 116 (25.9%) patients. Based on patient-level data, 53% (n = 47) were responders (≥50% improvement), of which 34% reached remission (MADRS ≤ 10 or BDI ≤ 11). BDI mean improvement was 16.7 (44.0%) after a second procedure (n = 19). (4) Conclusions: The results are supportive of the benefit of SRA in selected patients with refractory MDD.

show abstract

“…In a MRgFUS study for MDD, all four patients responded to the treatment with an at least 50% improvement in the HAM-D total score [116]. Permanent physical, neurological or psychological complications were not observed, but the body weight of all patients increased (mean weight: + 7.5 kg after 12 months) [116]. A further MRgFUS study for MDD reported that 33.3% of patients (2 of 6) responded [114].…”

Section: Recommendations For Magnetic Resonance-guided Focused Ultras...mentioning

confidence: 95%

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

et al. 2022

View full text Add to dashboard Cite

Background Psychiatric neurosurgery is experiencing a revival. Beside deep brain stimulation (DBS), several ablative neurosurgical procedures are currently in use. Each approach has a different profile of advantages and disadvantages. However, many psychiatrists, ethicists, and laypeople are sceptical about psychiatric neurosurgery. Methods We identify the main concerns against psychiatric neurosurgery, and discuss the extent to which they are justified and how they might be overcome. We review the evidence for the effectiveness, efficacy and safety of each approach, and discuss how this could be improved. We analyse whether and, if so, how randomised controlled trials (RCTs) can be used in the different approaches, and what alternatives are available if conducting RCTs is impossible for practical or ethical reasons. Specifically, we analyse the problem of failed RCTs after promising open-label studies. Results The main concerns are: (i) reservations based on historical psychosurgery, (ii) concerns about personality changes, (iii) concerns regarding localised interventions, and (iv) scepticism due to the lack of scientific evidence. Given the need for effective therapies for treatment-refractory psychiatric disorders and preliminary evidence for the effectiveness of psychiatric neurosurgery, further research is warranted and necessary. Since psychiatric neurosurgery has the potential to modify personality traits, it should be held to the highest ethical and scientific standards. Conclusions Psychiatric neurosurgery procedures with preliminary evidence for efficacy and an acceptable risk–benefit profile include DBS and micro- or radiosurgical anterior capsulotomy for intractable obsessive–compulsive disorder. These methods may be considered for individual treatment attempts, but multi-centre RCTs are necessary to provide reliable evidence.

show abstract

Bilateral thermal capsulotomy with magnetic resonance‐guided focused ultrasound for patients with treatment‐resistant depression: A proof‐of‐concept study

Cited by 15 publications

References 5 publications

Ablation Surgeries for Treatment-Resistant Depression: A Meta-Analysis and Systematic Review of Reported Case Series

Ablation Surgeries for Treatment-Resistant Depression: A Meta-Analysis and Systematic Review of Reported Case Series

Stereotactic Radiofrequency Ablation for Treatment-Refractory Depression: A Systematic Review and Meta-Analysis

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

Contact Info

Product

Resources

About