Obsessive-Compulsive Disorder (OCD) 

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Focused Ultrasound Therapy

Focused ultrasound is a noninvasive therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with obsessive compulsive disorder (OCD). This novel technology focuses beams of ultrasonic energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.

How it Works
Where the beams converge, focused ultrasound produces precise ablation (thermal destruction of tissue) of the desired target which treats OCD without incisions or radiation.

Advantages
Current treatments for OCD include medications, surgery (radiofrequency or laser ablation, deep brain stimulation), or stereotactic radiosurgery (gamma knife, linear accelerator), all of which have limitations and side effects.

Focused ultrasound has the potential to provide an alternative to invasive surgery or radiosurgery via precise thermal ablation, or to augment drug therapy.  It is noninvasive and has reduced risk for infection and blood clots. Focused ultrasound can also offer precise targeting to minimize damage to non-targeted healthy brain.

Clinical Trials

A clinical trial using low intensity focused ultrasound is recruiting patients with OCD.

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Regulatory Approval and Reimbursement

Focused ultrasound is not approved by any regulatory bodies worldwide as a treatment for OCD, nor is the treatment reimbursed by medical insurance providers.

Additional Resources

Notable Papers

Hamani C, Davidson B, Rabin JS, Goubran M, Boone L, Hynynen K, De Schlichting E, Meng Y, Huang Y, Jones RM, Baskaran A, Marawi T, Richter MA, Levitt A, Nestor SM, Giacobbe P, Lipsman N. Long-term safety and efficacy of focused ultrasound capsulotomy for obsessive-compulsive disorder and major depressive disorder. Biol Psychiatry. 2024 Aug 24:S0006-3223(24)01548-8. doi: 10.1016/j.biopsych.2024.08.015. PMID: 39187171 

Henn MC, Smith HD, Lopez Ramos CG, Shafie B, Abaricia J, Stevens I, Rockhill AP, Cleary DR, Raslan AM. A systematic review of focused ultrasound for psychiatric disorders: current applications, opportunities, and challenges. Neurosurg Focus. 2024 Sep 1;57(3):E8. doi: 10.3171/2024.6.FOCUS24278. PMID: 39217636 

Hurwitz TA, Avecillas-Chasin JM, Bogod NM, Honey CR. Ventral targeted anterior capsulotomy for treatment-resistant depression and obsessive-compulsive disorder: A treatment method with cases. J Affect Disord. 2024 Jan 23;350:887-894. doi: 10.1016/j.jad.2024.01.176. PMID: 38272366 

Guinjoan SM. Personalized Definition of Surgical Targets in Major Depression and Obsessive-Compulsive Disorder: A Potential Role for Low-Intensity Focused Ultrasound? Pers Med Psychiatry. 2023;37-38:100100. doi: 10.1016/j.pmip.2023.100100. Epub 2023 Feb 27.

Chang JG, Kim DW, Jung HH, Chang WS, Kim CH, Kim SJ, Chang JW. Evaluation of changes in neural oscillation after bilateral capsulotomy in treatment refractory obsessive-compulsive disorder using magnetoencephalogram. Asian J Psychiatr. 2023 Jan 20;82:103473. doi: 10.1016/j.ajp.2023.103473.

Mustroph ML, Cosgrove GR, Williams ZM. The Evolution of Modern Ablative Surgery for the Treatment of Obsessive-Compulsive and Major Depression Disorders. Front Integr Neurosci. 2022 Apr 6;16:797533. doi: 10.3389/fnint.2022.797533. eCollection 2022.

Germann J, Elias GJB, Neudorfer C, Boutet A, Chow CT, Wong EHY, Parmar R, Gouveia FV, Loh A, Giacobbe P, Kim SJ, Jung HH, Bhat V, Kucharczyk W, Chang JW, Lozano AM. Potential optimization of focused ultrasound capsulotomy for obsessive compulsive disorder. Brain. 2021 Jun 18:awab232. doi: 10.1093/brain/awab232.

Etherington LA, Matthews K, Akram H. New Directions for Surgical Ablation Treatment of Obsessive Compulsive Disorder. Curr Top Behav Neurosci. 2021 Feb 10. doi: 10.1007/7854_2020_207.

Davidson B, Hamani C, Meng Y, Baskaran A, Sharma S, Abrahao A, Richter MA, Levitt A, Giacobbe P, Lipsman N, Rabin JS. Examining cognitive change in magnetic resonance-guided focused ultrasound capsulotomy for psychiatric illness. Transl Psychiatry. 2020 Nov 11;10(1):397. doi: 10.1038/s41398-020-01072-1.

Davidson B, Mithani K, Huang Y, Jones RM, Goubran M, Meng Y, Snell J, Hynynen K, Hamani C, Lipsman N. Technical and radiographic considerations for magnetic resonance imaging-guided focused ultrasound capsulotomy. J Neurosurg. 2020 Sep 25:1-9. doi: 10.3171/2020.6.JNS201302.

Davidson B, Hamani C, Rabin JS, Meng Y, Richter MA, Giacobbe P, Lipsman N. Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Musical Obsessions. Biol Psychiatry. 2020 Aug 27:S0006-3223(20)31743-1. doi: 10.1016/j.biopsych.2020.07.005.

Davidson B, Hamani C, Huang Y, Jones RM, Meng Y, Giacobbe P, Lipsman N. Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders. Oper Neurosurg (Hagerstown). 2020 Jul 31:opaa240. doi: 10.1093/ons/opaa240.

Davidson, B., Hamani, C., Rabin, J.S. et al. Magnetic resonance-guided focused ultrasound capsulotomy for refractory obsessive compulsive disorder and major depressive disorder: clinical and imaging results from two phase I trials. Mol Psychiatry (2020). doi: 10.1038/s41380-020-0737-1.

Kumar KK, Bhati MT, Ravikumar VK, Ghanouni P, Stein SC, Halpern CH. MR-Guided Focused Ultrasound Versus Radiofrequency Capsulotomy for Treatment-Refractory Obsessive-Compulsive Disorder: A Cost-Effectiveness Threshold Analysis. Front Neurosci. 2019 Feb 7;13:66. doi: 10.3389/fnins.2019.00066. eCollection 2019.

Kim SJ, Roh D, Jung HH, Chang WS, Kim CH, Chang JW. A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive-compulsive disorder: 2-year follow-up. J Psychiatry Neurosci. 2018 Aug;43(5):327-337.

Jung HH, Chang WS, Kim SJ, Kim CH, Chang JW. The Potential Usefulness of Magnetic Resonance Guided Focused Ultrasound for Obsessive Compulsive Disorders. J Korean Neurosurg Soc. 2018 Apr 10. doi: 10.3340/jkns.2017.0505.004.

Gong F, Li P, Li B, Zhang S, Zhang X, Yang S, Liu H, Wang W. A study of cognitive function in treatment-refractory obsessive-compulsive disorder treated with capsulotomy. J Neurosurg. 2018 Feb;128(2):583-595. doi: 10.3171/2016.9.JNS152494. Epub 2017 Mar 24.

Chang WS, Jung HH, Zadicario E, Rachmilevitch I, Tlusty T, Vitek S, Chang JW. Factors associated with successful magnetic resonance-guided focused ultrasound treatment: efficiency of acoustic energy delivery through the skull. J Neurosurg. 2016 Feb;124(2):411-6. doi: 10.3171/2015.3.JNS142592.

Brown LT, Mikell CB, Youngerman BE, Zhang Y, McKhann GM 2nd, Sheth SA. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg. 2016 Jan;124(1):77-89. doi: 10.3171/2015.1.JNS14681. Epub 2015 Aug 7. Review.

Jung HH, Kim SJ, Roh D, Chang JG, Chang WS, Kweon EJ, Kim CH, Chang JW. Bilateral thermal capsulotomy with MR-guided focused ultrasound for patients with treatment-refractory obsessive-compulsive disorder: a proof-of-concept study. Mol Psychiatry. 2015 Oct;20(10):1205-11. doi: 10.1038/mp.2014.154.

Jung HH, Chang WS, Rachmilevitch I, Tlusty T, Zadicario E, Chang JW. Different magnetic resonance imaging patterns after transcranial magnetic resonance-guided focused ultrasound of the ventral intermediate nucleus of the thalamus and anterior limb of the internal capsule in patients with essential tremor or obsessive-compulsive disorder. J Neurosurg. 2015 Jan;122(1):162-8. doi: 10.3171/2014.8.JNS132603.

Click here for additional references from PubMed.

Clinical Trials