Focused Ultrasound For Treatment Resistant Obsessive Compulsive Disorder Showing Promise

Doctors at Sunnybrook Health Sciences in Toronto, Canada are using focused ultrasound (FUS) treatments to treat patients with obsessive-compulsive disorder(OCD). Nir Lipsman, MD, PhD, and Peter Giacobbe, MS, MSc, spoke with Psychiatric Times in a 2 part series about the treatment process and how psychiatrists and neurosurgeons are working together to bring relief to patients with OCD.

Patients in the study have been diagnosed with treatment resistant OCD and depression. Giacobbe said that the study highlights a growing interest in circuit based therapeutics for patients with treatment resistant mood and anxiety disorders.

The psychiatric neurosurgery lesions a part of the brain to change the structure for positive therapeutic effect, Giacobbe said. He said the study has provided evidence for the safety and efficacy of the treatment.

Lipsman said about one-third of patients with OCD and depression may not respond to guideline concordant care.

"The whole impetus for the field of surgical psychiatry is to offer viable, evidence driven approaches for patients with treatment resistant psychiatric conditions," Lipsman said.

The helmet-like device is lined with 1,000 transducers of ultrasound that can be directed to discreet regions of the brain, generating heat and creating a permanent lesion where the ultrasound waves interept.

The option of having focused ultrasound requires a nuanced approach, Giacobbe said, when discussing treatment with patients. The single procedure is attractive to patients who must travel to be treated and allows for more patients, locally and globally, to be treated.

"I think people are reassured by the fact that this is an approach that has been championed in the treatment of neurological disorders," Giacobbe said.

While effects are not immediate, data shows the effect tends to accrue over time.

Trainees and practitioners are embracing the neuroscience model and approach for interventional psychiatry, but Giacobbe said researchers must play the long game for this treatment to grow in utilization.

This is part 1 of a 2 part conversation. Stay tuned for part 2.

Dr Nir Lipsman is a senior scientist at Sunnybrook Health Sciences in Toronto, Canada. He is currently the Director of Sunnybrook's Harquail Centre for Neuromodulation and Clinical Director of the Focused Ultrasound Centre of Excellence. Dr Peter Giacobbe is an associate scientist at Sunnybrook Health Sciences in Toronto, Canada. He is a staff psychiatrist at the University Health Network in Toronto, where he serves as the Head of the Electroconvulsive Therapy Service, co-Head of the rTMS service and Director of the Fellowship Program.