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 (Mtime 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.

中文翻译：

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间质性激光囊切开术治疗难治性强迫症后冷漠感增加

背景 MRI 引导激光间质热疗 (M-LITT) 囊切开术已被证明可有效减少难治性强迫症 (OCD) 相关症状，但通过放射外科或射频消融进行的囊切开术在一些患者中导致术后冷漠程度增加。当前的病例系列旨在调查患者通过 M-LITT 治疗强迫症进行前囊切开术后客观报告的冷漠、去抑制、抑郁和执行功能障碍的变化。方法 10 名连续患者在 M-LITT 前后完成了强迫症、冷漠、去抑制、执行功能障碍和抑郁的测量（Mtime = 1.3 年；0.42-3.7 年）。可靠变化指数 (RCI) 用于评估 M-LITT 前后的变化。使用百分比变化评估强迫症症状反应（Y-BOCS 评分：减少 24-34% 表示部分缓解；减少 ≥35% 表示完全缓解）。结果强迫症症状在手术后出现了积极的变化，超过 65% 的人报告部分或完全缓解。然而，六名患者赞同冷漠情绪增加，其中一半无反应者（例如，Y-BOCS 得分降低<24%）报告冷漠情绪增加。患者报告相对稳定的去抑制和执行功能障碍，而超过一半的患者报告抑郁症状减轻。尽管抑郁症状、去抑制和执行功能障碍稳定或改善，但两名无反应者和一名反应者表示冷漠程度有所增加。结论 当前队列中的大多数患者实现了强迫症的完全或部分康复。然而，60% 的患者表示，尽管抑郁症状有所减轻，但冷漠程度却显着增加，并出现稳定的去抑制和执行功能障碍。尽管 M-LITT 后强迫症症状有这些有希望的改善，但显然有必要使用客观、可量化的方法进一步研究手术和病变位置对冷漠水平的影响。