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Incision-free surgery for obsessive-compulsive disorder and depression is safe, study finds

May 13, 2020

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In the first published study of its kind in North America, Sunnybrook researchers have demonstrated that MRI-guided focused ultrasound (FUS) for treatment-resistant major depression and obsessive-compulsive disorder (OCD), is safe and effective in improving symptoms for patients with these common mental health disorders.

The study has been published in Molecular Psychiatry.

“Our study supports the importance of continued research into focused ultrasound as a safe and innovative treatment approach for patients with difficult to treat OCD and depression,” says Dr. Nir Lipsman the study’s principal investigator and Director of the Harquail Centre for Neuromodulation at Sunnybrook. “Patients with these debilitating neuropsychiatric conditions have tried conventional treatments without success and are in need of novel treatment options.”

FUS uses ultrasound energy to target specific areas of the brain and body. It is a non-invasive, image-guided surgical technology considered to be scalpel-free, avoiding incisions to the skin.

The two first in North America, Phase I trials for FUS in treatment-resistant OCD and in major depression included twelve patients. FUS was used to target and cause a lesion in a brain pathway known to be active in both mental health disorders. This region of the brain is called the anterior limb of the internal capsule (ALIC) and is connected to areas of the brain involved with anxiety and other emotions. The idea is to interrupt these fibres to help improve communication in the brain.

Over the year-long study, patients participated in testing for depression, OCD, thinking and memory skills. Researchers found cognitive ability was not negatively impacted by MRI-guided FUS. Fifty percent of patients reported an improvement in their quality of life.

“We demonstrated that FUS is effective in significantly improving symptoms of patients with treatment-resistant OCD and depression,” says Dr. Benjamin Davidson, the study’s lead author. “‘Improvement’ means something different for each individual. It may mean being able to return to work, re-engaging with family or friends, being able to leave the house, or become more independent. Timing is gradual as well. It may take many months for patients to notice any changes in symptoms.”

In 2017, Jeffrey Kotas became the first patient in North America to be treated with FUS for OCD. Over the years his obsessions with perfection and cleanliness kept him mostly housebound. He eventually had to stop his university education. Jeffrey had tried various treatments for his OCD including dozens of medications and therapies, without success.

“I thought I would never stop suffering because of my illness,” explains Jeffrey. “After receiving focused ultrasound, I was able to go outside and my anxiety gradually diminished. It allowed me to take steps in my treatment that I previously had not been able to. Eventually, I participated in an intensive residential treatment program at Sunnybrook. Now, I am thinking about going back to school and I enjoy traveling, which was something I couldn’t do before.”

“Focused ultrasound is a promising option for patients with complex OCD,” says Dr. Peggy Richter, co-investigator and head of Sunnybrook’s Frederick W. Thompson Anxiety Disorders Centre. “It is a novel way of targeting the illness in the brain and because of this precision, there are fewer risks and side effects.”

Of the study participants who did not see an improvement, researchers say this may be due to challenges targeting key areas with FUS because of skull thickness or unique brain structure. The study also found that OCD responded better to the FUS treatment than depression, as 66 percent of patients with OCD versus 33 percent of those with depression made significant improvements. Researchers say this could result from the underlying differences between these disorders in the brain.

Researchers emphasize that FUS is not a “one-stop” treatment solution. Patients must work with their health care providers to determine appropriate treatment for their needs.

“Focused ultrasound may be an option for some patients as part of a broader treatment plan that can be personalized for each individual,” says Dr. Anthony Levitt, co-investigator and Chief of Sunnybrook’s Hurvitz Brain Sciences Program. “This technology offers a safe direct-to-brain approach to treatment, which could potentially be combined with psychotherapy, medication or other treatment options.”

Philanthropic investment has been instrumental in driving Sunnybrook’s advances in FUS technology and research. The trial is supported by the Focused Ultrasound Foundation in addition to leading donors including the Harquail family through the Midas Touch Foundation and the Robinson family.

“The continued pursuit of innovative treatments is key in the discovery of solutions to help improve quality of life for our patients,” says Dr. Kullervo Hynynen, study co-investigator, and Vice President of Research and Innovation, and pioneer of FUS. “Research is instrumental in demonstrating safe and novel ways of conquering health challenges.”

“The study findings offer hope for the future for patients and families who are searching for new treatments,” says Dr. Neal F. Kassell, MD, Chairman of the Focused Ultrasound Foundation. “Sunnybrook is one of the Foundation’s Centres of Excellence in focused ultrasound, and the site is a leader in all facets of focused ultrasound research. We are proud to support this innovative team.”


Media contact:

Jennifer Palisoc
Communications Advisor
416-480-4040
jennifer.palisoc@sunnybrook.ca

About the Focused Ultrasound Foundation

The Focused Ultrasound Foundation was created to improve the lives of millions of people worldwide by accelerating the development of focused ultrasound, an early-stage, noninvasive, therapeutic technology with the potential to transform the treatment of many serious medical disorders. The Foundation works to clear the path to global adoption by coordinating and funding research, fostering collaboration, and building awareness among patients and professionals. It is dedicated to ensuring that focused ultrasound finds its place as a mainstream therapy for a range of conditions within years, not decades. Since its establishment in 2006, the Foundation has become the largest non-governmental source of funding for focused ultrasound research. More information can be found at fusfoundation.org.

About Sunnybrook

Sunnybrook Health Sciences Centre is inventing the future of health care for the 1.3 million patients the hospital cares for each year through the dedication of its more than 10,000 staff and volunteers. An internationally recognized leader in research and education and a full affiliation with the University of Toronto distinguishes Sunnybrook as one of Canada’s premier academic health sciences centres. Sunnybrook specializes in caring for high-risk pregnancies, critically-ill newborns and adults, offering specialized rehabilitation and treating and preventing cancer, cardiovascular disease, neurological and psychiatric disorders, orthopaedic and arthritic conditions and traumatic injuries. The Hospital also has a unique and national leading program for the care of Canada’s war veterans.

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