Increased apathy post-interstitial laser capsulotomy for refractory obsessive-compulsive disorder

Hannah A Hagy; Maureen Lacy; Nataliya Turchmanovych-Hienkel; Jon E Grant; Daniel Biro; Peter C Warnke

doi:10.1136/jnnp-2023-333117

Increased apathy post-interstitial laser capsulotomy for refractory obsessive-compulsive disorder

J Neurol Neurosurg Psychiatry. 2024 Apr 16:jnnp-2023-333117. doi: 10.1136/jnnp-2023-333117. Online ahead of print.

Authors

Hannah A Hagy¹, Maureen Lacy¹, Nataliya Turchmanovych-Hienkel², Jon E Grant², Daniel Biro³, Peter C Warnke³

Affiliations

¹ Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA hannah.m.alves@gmail.com mlacy@uchicagomedicine.org.
² Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois, USA.
³ Department of Neurological Surgery, The University of Chicago, Chicago, Illinois, USA.

PMID: 38627023
DOI: 10.1136/jnnp-2023-333117

Abstract

Background: MRI guided laser interstitial thermal therapy (M-LITT) capsulotomy has proven to be efficacious in decreasing refractory obsessive-compulsive disorder (OCD) related symptomatology yet capsulotomy either via radiosurgery or radiofrequency ablation has in some patients led to increased apathy following surgery. The current case series aims to investigate objective patient-reported change in apathy, disinhibition, depression, and executive dysfunction following anterior capsulotomy via M-LITT for OCD.

Methods: Ten consecutive patients pre- and post-M-LITT completed measures of OCD, apathy, disinhibition, executive dysfunction, and depression (M_{time between} = 1.3 years; 0.42-3.7 years). Reliable Change Index (RCI) was used to evaluate change in pre- and post-M-LITT. OCD symptom response was evaluated using percent change (Y-BOCS scores: 24-34 % reduction indicating partial response; ≥35% reduction indicating full response).

Results: Positive post-surgical change was noted in OCD symptomatology with >65% reporting a partial or full response. However, six patients endorsed increased apathy with half of the non-responders (e.g., less than <24% score reduction on Y-BOCS) reporting increases in apathy. Patients reported relatively stable disinhibition and executive dysfunction, while over half reported a decrease in depression symptoms. Two of the non-responders and one responder endorsed increased apathy despite stable or improved depression symptoms, disinhibition, and executive dysfunction.

Conclusions: Most patients in the current cohort achieved full-or-partial OCD recovery. Yet, 60% of patients also reported significant increases in apathy, despite experiencing a decrease in depression symptoms, with stable disinhibition and executive dysfunction. Despite these promising improvements in OCD symptomatology following M-LITT, further investigations of the impact of surgery and lesion location on apathy levels is clearly warranted using objective, quantifiable methods.

Keywords: APATHY; NEUROPSYCHIATRY; NEUROSURGERY.