Gamma Knife Radiation Surgery Confirms Effectiveness in Treating Intractable OCD
Jul 28, 2024
A research team at Seoul National University Hospital recently published a study that proved gamma knife radiation surgery is an effective and safe treatment for intractable obsessive-compulsive patients. This study is expected to be of great help in selecting patients in the future by revealing the characteristics of patients who respond well to gamma knife radiation surgery.
Professor Kwon Jun-su's team at Seoul National University Hospital's Department of Neurosurgery Baek Sun-ha and Mental Health Medicine (Jang Moon-young, clinical instructor) announced the results of a study on the 26th that evaluated treatment reactions and side effects after performing gamma knife radiation surgery on 10 patients diagnosed with refractory obsessive compulsion from January 2017 to December 2023.
Obsessive compulsive disorder (compulsive disorder) is a common psychiatric disorder worldwide, with a lifetime prevalence of up to 3%. The disease usually develops at an early age, has a chronic course, and recurrence is frequent. Although medication and cognitive behavioral therapy are mainly performed as the first-line treatments for patients with obsessive-compulsive disorder, about 20% of patients do not respond to these treatments, requiring new alternative treatments.
Recent advances in neurosurgical technology have opened up new treatments for patients with mental illness who do not respond to existing drug treatments, and one of them is 'gamman knife radiation surgery'. Gamma Knife Radiation Surgery is a method of minimally invasive treatment of certain areas of the brain using high-intensity gamma rays, which blocks neural circuits that cause obsessive-compulsive symptoms. The surgery is safe because it can regulate the neural circuits of obsessive-compulsive disorder with minimal damage to surrounding healthy tissues, and it permanently destroys the lesion site, alleviating symptoms.
Clinical studies of obsessive-compulsive patients who have undergone gamma-knife radiation surgery are not many worldwide and are not well known, especially regarding predictions of which group of obsessive-compulsive patients responds well to gamma-knife radiation surgery.
The research team evaluated the changes in patients' obsessive-compulsive symptoms using the Yale-Brown OCD Scale (YBOCS) and compared the characteristics between patients who responded well to gamma knife radiation surgery and those who did not. The patient's clinical characteristics were analyzed by various variables such as gender, age, onset age, number of hospitalizations, and history of suicide attempts.
As a result, 50% of the 10 intractable obsessive-compulsive patients in the study had a complete response (reduced YBOCS score of more than 35% after treatment), and 20% had a partial response (reduced YBOCS score of 20% to 35% after treatment). The complete response means that the patient's obsessive symptoms have improved considerably, resulting in a major positive change in daily life, and the partial response means that the patient's obsessive symptoms have improved to some extent, but some symptoms remain. This means that 7 out of 10 patients had improved obsessive-compulsive symptoms after gamma knife radiation surgery.
Notably, one of the patients who fully responded achieved complete remission with a YBOCS score of 0 at the last follow-up.
The mean YBOCS score decreased significantly from 26.2 before treatment to 16.9 after treatment, confirming symptom improvement. This suggests that gamma knife radiation surgery may be effective in patients who do not respond to conventional treatments.
In addition, the research team analyzed the characteristics of patients with good response to gamma knife radiation surgery and found that ▲the average age of onset was high (20.2 years old) ▲the duration of the disease was short (less than 10 years) ▲the number of hospitalizations was low ▲the major depressive disorder (MDD) was often accompanied. This suggests that it can be useful for future patient screening and development of customized treatment strategies.
On the other hand, patients who responded poorly to gamma knife radiation surgery showed ▲the average age of onset was low (14 years) ▲the duration of the disease was long (20 years or more) ▲the number of hospitalizations was high ▲the history of suicide attempts. This suggests that these patients require additional treatment approaches in addition to gamma knife radiation surgery.
Patients who underwent gamma-knife radiosurgery had minor side effects, such as increased fatigue and sleep, but generally did not cause persistent dysfunction as a temporary symptom.
Professor Junsu Kwon (Department of Mental Health Medicine) stated, "This study is significant in that we have discovered the characteristics of intractable obsessive-compulsive patients who are effective in gamma-knife radiation surgery.
We have found that certain characteristics of patients can have a significant impact on the effectiveness of gamma-knife radiation surgery, which will provide important information for future patient screening."
Professor Baek Sun-ha (neurosurgery) added "It is meaningful in that gamma knife radiation surgery has led to a great improvement in symptoms for intractable mental diseases such as obsessive compulsive disorder that do not respond to drugs"
The results of this study were published in the recent issue of the international journal of the Korean Society of Neuropsychiatric Association 'Psychiatry Investigation'.
Professor Kwon Jun-su's team at Seoul National University Hospital's Department of Neurosurgery Baek Sun-ha and Mental Health Medicine (Jang Moon-young, clinical instructor) announced the results of a study on the 26th that evaluated treatment reactions and side effects after performing gamma knife radiation surgery on 10 patients diagnosed with refractory obsessive compulsion from January 2017 to December 2023.
Obsessive compulsive disorder (compulsive disorder) is a common psychiatric disorder worldwide, with a lifetime prevalence of up to 3%. The disease usually develops at an early age, has a chronic course, and recurrence is frequent. Although medication and cognitive behavioral therapy are mainly performed as the first-line treatments for patients with obsessive-compulsive disorder, about 20% of patients do not respond to these treatments, requiring new alternative treatments.
Recent advances in neurosurgical technology have opened up new treatments for patients with mental illness who do not respond to existing drug treatments, and one of them is 'gamman knife radiation surgery'. Gamma Knife Radiation Surgery is a method of minimally invasive treatment of certain areas of the brain using high-intensity gamma rays, which blocks neural circuits that cause obsessive-compulsive symptoms. The surgery is safe because it can regulate the neural circuits of obsessive-compulsive disorder with minimal damage to surrounding healthy tissues, and it permanently destroys the lesion site, alleviating symptoms.
Clinical studies of obsessive-compulsive patients who have undergone gamma-knife radiation surgery are not many worldwide and are not well known, especially regarding predictions of which group of obsessive-compulsive patients responds well to gamma-knife radiation surgery.
The research team evaluated the changes in patients' obsessive-compulsive symptoms using the Yale-Brown OCD Scale (YBOCS) and compared the characteristics between patients who responded well to gamma knife radiation surgery and those who did not. The patient's clinical characteristics were analyzed by various variables such as gender, age, onset age, number of hospitalizations, and history of suicide attempts.
As a result, 50% of the 10 intractable obsessive-compulsive patients in the study had a complete response (reduced YBOCS score of more than 35% after treatment), and 20% had a partial response (reduced YBOCS score of 20% to 35% after treatment). The complete response means that the patient's obsessive symptoms have improved considerably, resulting in a major positive change in daily life, and the partial response means that the patient's obsessive symptoms have improved to some extent, but some symptoms remain. This means that 7 out of 10 patients had improved obsessive-compulsive symptoms after gamma knife radiation surgery.
Notably, one of the patients who fully responded achieved complete remission with a YBOCS score of 0 at the last follow-up.
The mean YBOCS score decreased significantly from 26.2 before treatment to 16.9 after treatment, confirming symptom improvement. This suggests that gamma knife radiation surgery may be effective in patients who do not respond to conventional treatments.
In addition, the research team analyzed the characteristics of patients with good response to gamma knife radiation surgery and found that ▲the average age of onset was high (20.2 years old) ▲the duration of the disease was short (less than 10 years) ▲the number of hospitalizations was low ▲the major depressive disorder (MDD) was often accompanied. This suggests that it can be useful for future patient screening and development of customized treatment strategies.
On the other hand, patients who responded poorly to gamma knife radiation surgery showed ▲the average age of onset was low (14 years) ▲the duration of the disease was long (20 years or more) ▲the number of hospitalizations was high ▲the history of suicide attempts. This suggests that these patients require additional treatment approaches in addition to gamma knife radiation surgery.
Patients who underwent gamma-knife radiosurgery had minor side effects, such as increased fatigue and sleep, but generally did not cause persistent dysfunction as a temporary symptom.
Professor Junsu Kwon (Department of Mental Health Medicine) stated, "This study is significant in that we have discovered the characteristics of intractable obsessive-compulsive patients who are effective in gamma-knife radiation surgery.
We have found that certain characteristics of patients can have a significant impact on the effectiveness of gamma-knife radiation surgery, which will provide important information for future patient screening."
Professor Baek Sun-ha (neurosurgery) added "It is meaningful in that gamma knife radiation surgery has led to a great improvement in symptoms for intractable mental diseases such as obsessive compulsive disorder that do not respond to drugs"
The results of this study were published in the recent issue of the international journal of the Korean Society of Neuropsychiatric Association 'Psychiatry Investigation'.
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