Gamma ventral capsulotomy for obsessive-compulsive disorder: a randomized clinical trial

Area of Science:

• Neurosurgery
• Psychiatry
• Radiosurgery

Background:

• Neurosurgical ablation has been used for intractable obsessive-compulsive disorder (OCD) for decades.
• No randomized clinical trials have previously evaluated neurosurgical procedures for psychiatric disorders.

Purpose of the Study:

• To assess the efficacy and safety of gamma ventral capsulotomy (GVC), a radiosurgery technique, for treating patients with intractable OCD.

Main Methods:

• A double-blind, placebo-controlled, randomized clinical trial was conducted with 16 patients with intractable OCD.
• Patients were randomized to receive either active GVC (n=8) or sham GVC (n=8).
• Efficacy was measured using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Clinical Global Impression-Improvement (CGI-I) Scale.

Main Results:

• At 12 months, 37.5% of patients receiving active GVC responded, compared to 0% in the sham group.
• Active GVC demonstrated significantly greater OCD symptom improvement than sham GVC at 12 months (Y-BOCS, P=.046).
• The most serious adverse event was an asymptomatic radiation-induced cyst in one patient.

Conclusions:

• Gamma ventral capsulotomy appears to be a beneficial treatment for intractable OCD, offering an alternative to deep-brain stimulation.
• Due to the inherent risks of psychiatric neurosurgery, procedures like GVC should be performed at specialized centers.