Abstract
Major Depressive Disorder (MDD) and Obsessive-Compulsive Disorder (OCD) are common
and potentially incapacitating conditions. Even when recognized and adequately treated,
in over a third of patients with these conditions the response to first-line pharmacological
and psychotherapeutic measures is not satisfactory. After more assertive measures
including pharmacological augmentation (and in the case of depression, transcranial
magnetic stimulation, electroconvulsive therapy, or treatment with ketamine or esketamine),
a significant number of individuals remain severely symptomatic. In these persons,
different ablation and deep-brain stimulation (DBS) psychosurgical techniques have
been employed. However, apart from the cost and potential morbidity associated with
surgery, on average only about half of patients show adequate response, which limits
the widespread application of these potentially life-saving interventions. Possible
reasons are considered for the wide variation in outcomes across different series
of patients with MDD or OCD exposed to ablative or DBS psychosurgery, including interindividual
anatomical and etiological variability. Low-intensity focused ultrasound (LIFU) is
an emerging technique that holds promise in its ability to achieve anatomically circumscribed,
noninvasive, and reversible neuromodulation of deep brain structures. A possible role
for LIFU in the personalized presurgical definition of neuromodulation targets in
the individual patient is discussed, including a proposed roadmap for clinical trials
addressed at testing whether this technique can help to improve psychosurgical outcomes.
Keywords
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Published online: February 27, 2023
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