장진우 (연세대학교 의과대학 신경외과학교실) | 한빛사논문 > 한빛사

한빛사논문

조회681

연세대학교 의과대학 신경외과학교실

CV File 126 kb

Brain, Published: 18 June 2021, awab232 | https://doi.org/10.1093/brain/awab232 Potential optimization of focused ultrasound capsulotomy for obsessive compulsive disorder

Jürgen Germann,¹ Gavin J. B. Elias,^1,† Clemens Neudorfer,^1,† Alexandre Boutet,^1,2,† Clement T. Chow,¹ Emily H. Y. Wong,¹ Roohie Parmar,¹ Flavia Venetucci Gouveia,³ Aaron Loh,¹ Peter Giacobbe,³ Se Joo Kim,⁴ Hyun Ho Jung,⁵ Venkat Bhat,⁶ Walter Kucharczyk,^1,2 Jin Woo Chang^5,* and Andres M. Lozano^1,*

¹Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
²Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
³Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
⁴Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
⁵Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
⁶Centre for Mental Health and Krembil Research Centre, University Health Network, Toronto, Canada

^†These authors contributed equally to this work

^*Correspondence to: Andres M. Lozano
399 Bathurst St., WW 4-431 Toronto Western Hospital , Toronto, ON M5T 2S8, Canada

^*Correspondence may also be addressed to: Jin Woo Chang
Brain Research Institute, Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea

Abstract

Obsessive-compulsive disorder is a debilitating and often refractory psychiatric disorder. Magnetic resonance-guided focused ultrasound is a novel, minimally invasive neuromodulatory technique that has shown promise in treating this condition. We investigated the relationship between lesion location and long-term outcome in obsessive-compulsive disorder patients treated with focused ultrasound to discern the optimal lesion location and elucidate the efficacious network underlying symptom alleviation. Postoperative images of eleven patients who underwent focused ultrasound capsulotomy were used to correlate lesion characteristics with symptom improvement at one year follow-up. Normative resting-state functional MRI and normative diffusion MRI-based tractography analyses were used to determine the networks associated with successful lesions. Obsessive-compulsive disorder patients treated with inferior thalamic peduncle deep brain stimulation (n = 5) and lesions from the literature implicated in obsessive-compulsive disorder (n = 18) were used for external validation. Successful long-term relief of obsessive-compulsive disorder was associated with lesions that included a specific area in the dorsal anterior limb of the internal capsule. Normative resting-state functional MRI analysis showed that lesion engagement of areas 24 and 46 was significantly associated with clinical outcomes (R = 0.79, p = 0.004). The key role of areas 24 and 46 was confirmed by (1) normative diffusion MRI-based tractography analysis showing that streamlines associated with better outcome projected to these areas, (2) association of these areas with inferior thalamic peduncle deep brain stimulation patients’ outcome (R = 0.83, p = 0.003); (3) the connectedness of these areas to obsessive-compulsive disorder-causing lesions, as identified using literature-based lesion network mapping. These results provide considerations for target improvement, outlining the specific area of the internal capsule critical for successful magnetic resonance-guided focused ultrasound outcome and demonstrating that discrete frontal areas are involved in symptom relief. This could help refine focused ultrasound treatment for obsessive-compulsive disorder and provide a network-based rationale for potential alternative targets.

Keywords : obsessive compulsive disorder, neuromodulation, focused ultrasound, MRgFUS, capsulotomy

논문정보

형식Research article
게재일2021년 06월 (BRIC 등록일 2021-06-23)
연구진국내(교신)+국외 연구진
분야 의약학 > 응용의학

댓글 작성 로그인

CV 열람하기

연락처 보기