RESUMO
Obsessive-compulsive disorder (OCD) affects 2-3% of the population. One-third of patients are poorly responsive to conventional therapies, and for a subgroup, gamma knife capsulotomy (GKC) is an option. We examined lesion characteristics in patients previously treated with GKC through well-established programs in Providence, RI (Butler Hospital/Rhode Island Hospital/Alpert Medical School of Brown University) and São Paulo, Brazil (University of São Paolo). Lesions were traced on T1 images from 26 patients who had received GKC targeting the ventral half of the anterior limb of the internal capsule (ALIC), and the masks were transformed into MNI space. Voxel-wise lesion-symptom mapping was performed to assess the influence of lesion location on Y-BOCS ratings. General linear models were built to compare the relationship between lesion size/location along different axes of the ALIC and above or below-average change in Y-BOCS ratings. Sixty-nine percent of this sample were full responders (≥35% improvement in OCD). Lesion occurrence anywhere within the targeted region was associated with clinical improvement, but modeling results demonstrated that lesions occurring posteriorly (closer to the anterior commissure) and dorsally (closer to the mid-ALIC) were associated with the greatest Y-BOCS reduction. No association was found between Y-BOCS reduction and overall lesion volume. GKC remains an effective treatment for refractory OCD. Our data suggest that continuing to target the bottom half of the ALIC in the coronal plane is likely to provide the dorsal-ventral height required to achieve optimal outcomes, as it will cover the white matter pathways relevant to change. Further analysis of individual variability will be essential for improving targeting and clinical outcomes, and potentially further reducing the lesion size necessary for beneficial outcomes.
Assuntos
Transtorno Obsessivo-Compulsivo , Radiocirurgia , Humanos , Brasil , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Transtorno Obsessivo-Compulsivo/cirurgia , Radiocirurgia/métodos , Resultado do Tratamento , Cápsula Interna/diagnóstico por imagem , Cápsula Interna/cirurgiaRESUMO
It has recently been demonstrated that vessel dilation induced by several physiological agents is dependent on an intact vascular endothelium. In order to explain this endothelium dependence, it has been hypothesized that a still unknown chemical substance, generically named Endothelium Dependent Relaxing Factor (EDRF) is necessary for physiological vasodilation. The role of this EDRF in the cerebrovascular physiology is not yet well understood. In this article the cerebrovascular physiological control is reviewed in relationship with possible EDRF actions. The importance of endothelial lesions in the cerebrovascular responses is discussed.
Assuntos
Produtos Biológicos/fisiologia , Circulação Cerebrovascular , Vasodilatação , Homeostase , Óxido NítricoRESUMO
Cerebral vasospasm is an important component of pathological entities such as migraine, subarachnoid hemorrhage (SAH), head trauma, post cerebral ischemia and/or hypoxia. The mechanisms underlying cerebral vasospasm in these diseases are not completely understood. Neurochemical and morphological factors involved in the cerebral circulation control are reviewed in this article. The circulatory changes observed after subarachnoid hemorrhage are taken as a model. It is concluded that multiple biochemical, physiological and morphological factors are involved in the cerebral vascular responses after SAH. Possible treatment alternatives for cerebral vasospasm based on its etiology are discussed.