Psychiatric Neurosurgery Program at Butler Hospital

Psychiatric Neurosurgery Program

Neurosurgical procedures can help patients suffering from treatment-resistant psychiatric and neurological conditions including OCD, depression, Tourette’s and movement disorders such as Parkinson’s disease. Ablative procedures create disruption in abnormal circuits through placement of circumscribed lesions. In deep brain stimulation (DBS), small electrodes are placed within target areas in the brain to modulate the functioning of the neuronal pathways in those regions. 

Obsessive-compulsive disorder (OCD) is a debilitating mental illness that affects approximately 2.2 million adults each year. It is estimated that about 1 in 40 adults and 1 in 100 children in the US have OCD. It is caused by abnormalities in brain circuitry that leads to uncontrollable and intrusive thoughts followed by specific rituals or compulsions. If these compulsions are not performed, an individual may have significant distress. There are many forms of conventional treatments available for OCD, including medication management and exposure and response prevention (ERP). Unfortunately, a subset of patients does not respond to standard treatments and may benefit from psychiatric neurosurgery, such as deep brain stimulation (DBS) or ablative/lesion procedures. At Butler Hospital and Rhode Island Hospital, we are worldwide experts in neurosurgery for severe OCD, and we offer DBS to the ventral capsule/ventral striatum, as well as anterior capsulotomy.

Capsulotomy

Capsulotomy is a controlled and targeted laser ablation of specific circuits involved in OCD within the ventral anterior internal capsule. Though we previously used the gamma knife to create these lesions, we are currently using an MRI guided technique called LITT, or laser interstitial thermal therapy. During the  LITT procedure, thin laser fibers are inserted into the brain through small incisions and burr holes in the skull. Laser heat is then delivered through these fibers in order to create a small lesion, thus interrupting pathways thought to be abnormal in OCD. 

DBS

DBS has been widely practiced for movement disorders and was approved for use in OCD by the FDA under a “Humanitarian Device Exemption” in 2008, after a successful multi-center trial coordinated by Brown University. In DBS, small electrodes are placed at target locations in the brain through small burr holes; these electrodes are then regulated through a neurostimulator placed under the skin, much like a pacemaker. The stimulation acts to disrupt the abnormal impulses in the circuitry of the OCD brain. Both procedures are minimally invasive, relatively painless, and require short healing and recovery times.

Who can be considered for these procedures?

To be considered for these procedures, a patient must have severe OCD and have undergone all standard treatments for OCD (pharmacotherapy and exposure and response prevention for OCD). There will be a comprehensive review of treatment history and current symptoms in a screening visit with our multi-disciplinary team. The case will then be reviewed by our Psychiatric Neurosurgery Committee to determine if a patient is eligible for the procedure. 

We have been a pioneer in implementing and perfecting these techniques for patients with intractable OCD. Our sizeable number of successful patient outcomes are backed by groundbreaking research and innovation in this specific field by our outstanding clinical and research team.

For more information contact our team at (401) 455-6594, email nmclaughlin@butler.org

Frequently Asked Questions

Who is eligible for surgery?

You may be eligible to receive gamma ventral capsulotomy if you:

  • Are between the ages of 18 and 70 years old.
  • Have intractable OCD resulting in major functional impairment, and are in good general health.
  • Have health insurance that will pay for the procedure and associated clinical visits (such as neurological, neuropsychological assessments), or are willing to pay out of pocket.

Specific inclusion/exclusion criteria will be discussed with you during the initial screening.

What is the screening process?

The screening process has two main stages:

  1. Collecting information.
  2. An in-person evaluation.

If a participant appears eligible based upon presentation of initial records, he or she will undergo an evaluation in person. This evaluation will take place at Butler Hospital and will last approximately eight hours. The data will be reviewed by our Psychiatric Neurosurgery Committee, a multidisciplinary team of clinicians who specialize in this treatment. This team will determine if you are eligible for the procedure.

If you are deemed eligible and elect to have the procedure, you will undergo a pre-surgical evaluation the week before the procedure. This will include extensive physical, neurological, and cognitive testing to determine there are no neurological reasons not to undergo radiosurgery.

Who will perform the procedure?
The procedure will be performed by a neurosurgeon (Wael Asaad, MD, PhD) at Rhode Island Hospital, in conjunction with the OCD treatment team from Butler Hospital (Steven Rasmussen, MDBenjamin Greenberg, MD, PhDNicole McLaughlin, PhD). 
Where is the procedure performed?
The procedure (including a pre-operative MRI) will be carried out at Rhode Island Hospital. All associated clinical assessments and follow-up visits will take place at Butler Hospital. The research brain scans (if you choose to participate in associated studies) will be completed at the Brown University Magnetic Resonance Facility (MRF).
Are there reasonable overnight accommodations available near the hospitals and university?
Yes, there are various accommodations nearby. A few may accommodate their fee for out-of-state hospital patients.
Where do I follow-up after the procedure?
You will continue follow-up with your local treatment providers. Clinicians from our team will also continue to remain in touch with you by phone. Patients also return for follow-up in person one year after the treatment.

Meet the Team

 
Nicole C. McLaughlin, PhD

Program Director and Neuropsychologist
Butler Hospital

Dr. McLaughlin received her PhD in 2006 from Suffolk University, and completed her postdoctoral fellowship in 2008 at The Warren Alpert Medical School of Brown University. She is a neuropsychologist at Butler Hospital in Providence, RI, and an assistant professor at Alpert Medical School at Brown University. Dr. McLaughlin has been a Principal Investigator or Co-Investigator on several grants related to invasive and non-invasive treatments for OCD, and is the Director of Psychiatric Neurosurgery at Butler Hospital. She has authored or co-authored over 50 publications, many of which are related to OCD and related illnesses.

 

Steve A. Rasmussen, MD

Psychiatrist 
Butler Hospital

Dr. Rasmussen is currently the Mary Zucker Professor and Chair of the Department of Psychiatry and Human Behavior at the Alpert School of Medicine at Brown University. After graduating from Brown Medical School in 1977, he completed his psychiatry residency at Yale University. Since then, his career has focused on the psychopathology and treatment of OCD. Acclaimed internationally for his work in the field, Dr. Rasmussen has been recognized by The Best Doctors in America annually for over 20 years. He has authored and co-authored over 190 publications and has lectured at conferences and symposiums across the world. His research has been continuously funded by the NIH for over twenty years. Following his lead role in pharmacologic trials of the SRIs for OCD in the 1980's, he pioneered the development of lesion and DBS neurosurgical approaches for the treatment of intractable OCD in the 1990's. He was the 2011 recipient of the Leksell Pioneer in Radiosurgery Award as well as the 2014 recipient of the International OCD Foundation lifetime achievement award.

Benjamin D. Greenberg, MD, PhD

Psychiatrist
Butler Hospital

Benjamin Greenberg, MD, PhD, is a leading expert in anxiety, especially obsessive compulsive disorder (OCD) diagnosis, treatment and research. In addition to conventional medication treatments and behavior therapy for OCD, he has led development of the neurosurgical treatment of deep brain stimulation (DBS) for severe, intractable OCD in the U.S. Dr. Greenberg's background includes a PhD in Neurosciences from the University of California, San Diego, an MD from the University of Miami, training in neurology at Columbia University, and a psychiatry residency at Johns Hopkins Hospital. After residency, he worked for the Laboratory of Clinical Science at the National Institute of Mental Health. He subsequently became Chief of the Adult Obsessive-Compulsive Disorder (OCD) Research Unit, where he initiated studies in OCD using Transcranial Magnetic Stimulation (TMS).

In 2000, Dr. Greenberg joined the OCD Research Group at Butler Hospital and Brown Medical School. His main work now is developing brain stimulation treatments, either noninvasive or surgical, for people with OCD or other conditions. The noninvasive methods include TMS and electrical stimulation to the scalp (e.g., tDCS). Invasive or surgical therapies include Gamma Knife Ventral Capsulotomy for OCD and Deep Brain Stimulation for OCD. These efforts include collaborative translational research using neuroimaging, neuroanatomy, neurophysiology, and cognitive neuroscience techniques to better understand the neurocircuitry of OCD and other conditions, that are affected by neuromodulation. Dr. Greenberg also has interests in OCD symptom sub-typing and in OCD and personality genetics.

 

Wael Asaad, MD, PhD

Neurosurgeon
Rhode Island Hospital

Wael Asaad, MD, PhD received his undergraduate degree from Amherst College in 1993, then earned a PhD in systems neuroscience from Massachusetts Institute of Technology in 2001, and his MD from Yale University in 2003. Dr. Asaad completed a general surgery internship and neurosurgical residency at the Massachusetts General Hospital. During his residency, he undertook additional training in functional neurosurgery. In 2011, he joined the department of neurosurgery at The Warren Alpert Medical School of Brown University. 

Dr. Asaad’s clinical interests include functional neurosurgery for movement disorders and psychiatric disease, epilepsy surgery and traumatic brain injury.

His basic science interests focus on the ways in which neuronal circuits in the frontal cortex and basal ganglia underlie visual-motor learning, memory and decision-making, and how a better understanding of these might lead to strategies to alleviate the cognitive and affective aspects of psychiatric and neurological diseases.