Magnetic resonance-guided focused ultrasound capsulotomy for refractory obsessive compulsive disorder and major depressive disorder: clinical and imaging results from two phase I trials

Davidson, Benjamin; Hamani, Clement; Rabin, Jennifer S.; Goubran, Maged; Meng, Ying; Huang, Yuexi; Baskaran, Anusha; Sharma, Sachie; Ozzoude, Miracle; Richter, Margaret A.; Levitt, Anthony J.; Giacobbe, Peter; Hynynen, Kullervo; Lipsman, Nir

doi:10.1038/s41380-020-0737-1

Cited by 61 publications

(26 citation statements)

References 65 publications

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“…Since MRgFUS lesioning is guided by imaging rather than electrophysiology, it could benefit greatly from integration with imaging resources such as the human connectome. The normative structural connectome has already been used to investigate connections associated with side-effects following MRgFUS lesioning of the thalamus for Essential Tremor ( Boutet et al, 2018 ) and connections associated with clinical benefit following MRgFUS lesioning of the anterior limb of the internal capsule for OCD or Major Depressive Disorder ( Davidson et al, 2020 ).…”

Section: Eight Opportunities Of Connectomic Neuromodulationmentioning

confidence: 99%

Opportunities of connectomic neuromodulation

2020

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The process of altering neural activity – neuromodulation – has long been used to treat patients with brain disorders and answer scientific questions. Deep brain stimulation in particular has provided clinical benefit to over 150,000 patients. However, our understanding of how neuromodulation impacts the brain is evolving. Instead of focusing on the local impact at the stimulation site itself, we are considering the remote impact on brainregions connected to the stimulation site. Brain connectivity information derived from advanced magnetic resonance imaging data can be used to identify these connections and better understand clinical and behavioral effectsof neuromodulation. In this article, we review studies combining neuromodulation and brain connectomics, highlighting opportunities where this approach may prove particularly valuable. We focus on deep brain stimulation, but show that the same principles can be applied to other forms of neuromodulation, such as transcranial magnetic stimulation and MRI-guided focused ultrasound. We outline future perspectives and provide testable hypotheses for future work.

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Section: Eight Opportunities Of Connectomic Neuromodulationmentioning

confidence: 99%

Opportunities of connectomic neuromodulation

2020

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“…Each patient was assessed by two psychiatrists, as well as the neurosurgical team, to assess eligibility. Detailed inclusion/exclusion criteria were reported in a previous publication 38 . Briefly, patients were required to be refractory to at least three guidelineconcordant trials of antidepressants, two trials of augmentation or combination therapy and at least one trial of psychotherapy 39 .…”

Section: Participantsmentioning

confidence: 99%

“…Recently, our group reported preliminary results of two phase-1 trials treating patients with refractory OCD or MDD with MRgFUS-AC 38 . In that report, neuropsychological testing was available on 9/12 patients, and we found stable cognitive performance at the group level following AC.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Our results may have significant implications for the further expansion of tcMRgFUS unique clinical and research applications. Optimization of high-quality intraoperative imaging may be necessary for making the tcMRgFUS a feasible image-guided intervention for the precise intracranial tumor ablation [20,21], target identification in psychiatric disorders [22][23][24][25], and reversible controlled blood-brain barrier opening to enhance therapeutic drugs delivery in specific brain regions [26][27][28][29][30], even using 1.5-T MR scanners. In this context, precise intraoperative imaging may provide accurate real-time delineation of pathological areas and direct visualization of the targeted spot, increasing the preciseness of the procedure and ensuring the preservation of nontarget tissues.…”

Section: Discussion and Future Directionsmentioning

confidence: 99%

Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound with a 1.5 Tesla Scanner: A Prospective Intraindividual Comparison Study of Intraoperative Imaging

et al. 2021

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Background: High-quality intraoperative imaging is needed for optimal monitoring of patients undergoing transcranial MR-guided Focused Ultrasound (tcMRgFUS) thalamotomy. In this paper, we compare the intraoperative imaging obtained with dedicated FUS-Head coil and standard body radiofrequency coil in tcMRgFUS thalamotomy using 1.5-T MR scanner. Methods: This prospective study included adult patients undergoing tcMRgFUS for treatment of essential tremor. Intraoperative T2-weighted FRFSE sequences were acquired after the last high-energy sonication using a dedicated two-channel FUS-Head (2ch-FUS) coil and body radiofrequency (body-RF) coil. Postoperative follow-ups were performed at 48 h using an eight-channel phased-array (8ch-HEAD) coil. Two readers independently assessed the signal-to-noise ratio (SNR) and evaluated the presence of concentric lesional zones (zone I, II and III). Intraindividual differences in SNR and lesional findings were compared using the Wilcoxon signed rank sum test and McNemar test. Results: Eight patients underwent tcMRgFUS thalamotomy. Intraoperative T2-weighted FRFSE images acquired using the 2ch-FUS coil demonstrated significantly higher SNR (R1 median SNR: 10.54; R2: 9.52) compared to the body-RF coil (R1: 2.96, p < 0.001; R2: 2.99, p < 0.001). The SNR was lower compared to the 48-h follow-up (p < 0.001 for both readers). Intraoperative zone I and zone II were more commonly visualized using the 2ch-FUS coil (R1, p = 0.031 and p = 0.008, R2, p = 0.016, p = 0.008), without significant differences with 48-h follow-up (p ≥ 0.063). The inter-reader agreement was almost perfect for both SNR (ICC: 0.85) and lesional findings (k: 0.82–0.91). Conclusions: In the study population, the dedicated 2ch-FUS coil significantly improved the SNR and visualization of lesional zones on intraoperative imaging during tcMRgFUS performed with a 1.5-T MR scanner.

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Magnetic resonance-guided focused ultrasound capsulotomy for refractory obsessive compulsive disorder and major depressive disorder: clinical and imaging results from two phase I trials

Cited by 61 publications

References 65 publications

Opportunities of connectomic neuromodulation

Opportunities of connectomic neuromodulation

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

Transcranial Magnetic Resonance Imaging-Guided Focused Ultrasound with a 1.5 Tesla Scanner: A Prospective Intraindividual Comparison Study of Intraoperative Imaging

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