University Hospitals Cleveland Medical Center
One treatment for treatment-refractory OCD is a procedure called anterior capsulotomy, which modifies a part of the brain called the anterior limb of the internal capsule (ALIC). The ALIC contains connections between some regions of the brain that are overactive in OCD. Anterior capsulotomy can be done with a minimally invasive procedure called radiosurgery, which uses a one-time targeted radiation treatment to weaken the hyperactive connections that travel through the ALIC. Traditionally, radiosurgery was done using a machine called the Gamma Knife. Many radiation treatment centers use a different type of treatment machine, called a linear accelerator, to treat conditions in the brain that were traditionally treated on the Gamma Knife. This study will enroll 10 patients and offer anterior capsulotomy on a linear accelerator radiosurgery system and monitor participants OCD symptom improvement after the procedure. This study will also use a special type of brain imaging technique, called task-based functional MRI, to collect information about brain activity before and after treatment.
Inclusion Criteria: * Age 18 or older at time of enrollment * Documented diagnosis of Obsessive Compulsive Disorder (OCD) * Y-BOCS score of 28 or higher confirmed with behavioral testing during pre-existing clinical documentation * Two trials of selective serotonin reuptake inhibitors for an adequate duration at maximally tolerated dose OR one trial of a selective serotonin reuptake inhibitor with antipsychotic augmentation for an adequate duration at maximally tolerated dose OR one trial of a selective serotonin reuptake inhibitor and clomipramine for an adequate duration at maximally tolera…
Radiotherapy will consist of stereotactic radiotherapy, delivered in a single or staged treatment to the bilateral anterior limb of the internal capsule. A maximum dose of 140Gy will be prescribed to a single isocenter on each side.