Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness

Abstract

Magnetic resonance-guided focused ultrasound (MRgFUS) anterior capsulotomy is a novel treatment option for patients with refractory obsessive compulsive disorder (OCD) or major depressive disorder (MDD). However, there is concern that lesional psychiatric surgery procedures may have adverse effects on cognition. In this study, we examined whether MRgFUS capsulotomy causes cognitive decline in patients with psychiatric illness. Ten patients with refractory OCD (n = 5) or MDD (n = 5) underwent MRgFUS capsulotomy. Cognitive functioning was measured at baseline as well as 6 months and 12 months postoperatively, with a battery of neuropsychological tests assessing domains of executive function, memory, and processing speed. Scores were analyzed at the individual-level, and changes ≥2 standard deviations were considered clinically significant. We also examined whether changes in clinical symptoms were associated with changes in cognitive performance. At baseline intellectual functioning was in the average to high-average range for the group. Following MRgFUS capsulotomy, there were no deteriorations in cognition that reached ≥2 standard deviations at 6 or 12 months. Eight out of ten patients demonstrated a ≥2 standard deviation improvement in at least one cognitive score at 6 or 12 months postoperatively. Improvements in clinical symptoms correlated significantly with self-reported improvements in frontal lobe function (p < 0.05), but not with objective measures of cognitive functioning. To summarize, MRgFUS capsulotomy did not result in cognitive decline in this cohort of patients with refractory OCD or MDD, suggesting that this procedure can be offered to patients with a very low risk of cognitive side effects.

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

“…MRgFUS capsulotomy did not adversely impact cognitive function across several domains (study with 5 OCD and 5 MDD patients) [113].…”

“…Very recently, MRgFUS has been introduced into psychiatric neurosurgery [29,113]- [115]. MRg-FUS has proven efficacy, safety, and cost-efficiency for essential tremor [34,44] plus cost-efficiency for OCD [46].…”

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

“…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.…”

“…The Toronto group's (n = 6) [70] results have been less promising, reporting a responder rate of 20-33% at 12 months [70][71][72]. They report no significant permanent neurological, neuropsychological or psychobehavioral complications.…”

“…Moreover, they describe technical challenges utilizing this methodology. In 27% of cases, utilizing the trial's sonication parameters, they failed to create a lesion on either side of the brain [70].…”