Sonication-based OCD Neurosurgical Intervention Via Capsulotomy — SONIC  

Obsessive-Compulsive Disorder Clinical Trial

Official title: ExAblate MR-guided Focused Ultrasound Bilateral Anterior Capsulotomy for Treatment of Obsessive-Compulsive Disorder

Status Not yet recruiting

Clinical Trial Summary

The goal of this clinical trial is to determine if ExAblate MR-guided Focused Ultrasound (MRgFUS) bilateral anterior capsulotomy can be used safely and effectively to relieve symptoms of moderate to severe obsessive compulsive disorder (OCD) in individuals who have not benefited from psychotherapy and medications.

The main questions it aims to answer are:

1. Can ExAblate MRgFUS capsulotomy be safely delivered to individuals suffering from treatment-refractory OCD through an intact skull with a risk and side-effect profile that is comparable to other neurosurgical approaches for capsulotomy?

2. Will ExAblate MRgFUS capsulotomy result in improvement in clinical symptoms and quality of life metrics that are similar to those seen with other surgical approaches for capsulotomy?

In the first stage of the study, participants with severe, treatment resistant OCD (n=10) will be recruited in two centers (Harvard and Stanford) and treated with best medical care (BMT) for 6 months. Thereafter, they will receive the ExAblate MRgFUS procedure and then another BMT for 12 months. In the second stage of the study, participants with moderate to severe OCD (n=56) will be recruited in a multi-center study and treated with BMT plus real or sham MRgFUS for 12 months. Thereafter, those who received sham MRgFUS and did not improve will receive real MRgFUS and then treated with BMT for another 12 months.

Clinical Trial Description

The proposed study aims to establish the safety and efficacy of ExAblate MR-guided Focused Ultrasound (MRgFUS) for patients with treatment-refractory obsessive-compulsive disorder (OCD). Bilateral anterior thermo-capsulotomy and gamma-knife capsulotomy are well-known and effective treatments for treatment-refractory OCD patients. In this study, the investigators will use the ExAblate MRgFUS technology (Insightec Ltd) as a new method for capsulotomy for OCD patients. The ExAblate MRgFUS technology for neuro-related clinical applications has received FDA approval for Essential Tremor. In addition, the FDA approved an expansion of the ExAblate Neuro to include the treatment of tremor-dominant Parkinson's Disease. The study is designed to demonstrate safety and effectiveness and intended as a primary clinical support for a future marketing application.

The investigators propose a two-stage research protocol to establish the safety and efficacy of ExAblate MRgFUS for patients with treatment-resistant OCD. The first stage will be designed as a 'patient as own control' paradigm. Severe, treatment resistant OCD patients (n=10) will be recruited in two centers (Harvard and Stanford) and treated for 6 months by a best medical treatment (BMT) protocol followed by the ExAblate MRgFUS procedure plus BMT for another 12 months. The second stage will be designed as a 'double blind randomized control trial' paradigm. Moderate to severe, partially treatment resistant OCD patients (n=56) will be recruited in a multi-centered study and randomized into the ExAblate MRgFUS or sham procedures. They will be treated by BMT plus MRgFUS or BMT plus sham for 12 months followed by BMT plus the Exablate MRgFUS for the non-responding sham group for another 12 months.

This study is the first to evaluate ExAblate MRgFUS for OCD in the USA. This protocol was developed by two collaborating centers at Harvard and Stanford Universities, with two experienced and dedicated multidisciplinary teams of psychiatrists, neurosurgeons, psychologists, radiologists and neurologists. The suggested technical protocol using the ExAblate MRgFUS system for OCD is derived from a reported Korean study and an on-going Canadian clinical study.

The study is funded by the Focused Ultrasound Foundation and Insightec Ltd. ;

Related Conditions & MeSH terms

• Obsessive-Compulsive Disorder

• NCT number: NCT06131502
• Study type: Interventional
• Source: Brigham and Women's Hospital
• Status: Not yet recruiting
• Phase: Phase 1/Phase 2
• Start date: June 2024
• Completion date: June 2032