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Sonication-based OCD Neurosurgical Intervention Via Capsulotomy | Clinical Trials | Clareo Health

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Sonication-based OCD Neurosurgical Intervention Via Capsulotomy

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

NCT06131502•Brigham and Women's Hospital

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.

Detailed 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.

Eligibility

Age

25 - 64 years

Sex

ALL

Healthy Volunteers

Inclusion Criteria

•1. 25-64 years, inclusive.
•2. Patients who are able and willing to give consent and able to attend study visits, as determined by both study psychiatrist and the surgeon.
•3. DSM-5 diagnosis of Obsessive-Compulsive Disorder (OCD), at least 5-year illness history, with a minimum score of 28 on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) for stage I and a minimum score of 24 on Y-BOCS for stage II.
•4. Medication-refractoriness as determined by an adequate dose and duration of standard psychiatric treatments (including psychotherapy and/or pharmacology) as determined by psychiatrists associated with the study. Including specifically:
•1. Failed adequate trial of three or more medications accepted as first line in the treatment of OCD such as selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine, citalopram), selective serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs, e.g. clomipramine) or other antidepressants at the maximal tolerated dose. Adequate maximal doses and minimal duration of these medication are listed in Table 2 below.
•2. Attempted augmentation, if tolerated, by at least two medications known to be second line treatments for OCD such as clonazepam, haloperidol, risperidone, olanzapine, gabapentin.
•3. An adequate trial of cognitive behavioral therapy (CBT) delivered by a therapist experienced in treating OCD. Criteria for an adequate CBT are listed in Table 3 below.
•4. In stage II patients that cannot tolerate pharmacotherapy or participate in psychotherapy will be included in the study.
•5. A consistent dose of all medications in the 30 days prior to study entry
•6. Able to communicate sensations during the ExAblate MRgFUS treatment

Exclusion Criteria

•1. Presence of significant cognitive impairment (as measured by a score \<25 on the mini-mental state examination, MMSE)
•2. Lifetime diagnosis of psychosis or bipolar disorder or presence of suicidality (as measured by a score \>=2, item 9 of the BDI or high suicidal risk measured by the Columbia Suicide Severity Rating Scale (C-SSRS)). Subjects with stable, chronic anxiety or depressive disorders may be included provided their medications have been stable for at least 3 months prior to study entry and if deemed appropriately managed by the site psychiatrist.
•3. DSM-5 diagnosis of substance use disorder (SUD) within the past 6 months
•4. Patients with unstable cardiac status \[e.g. unstable angina pectoris on medication; patients' medication (other than diuretic); patients on anti-arrhythmic drugs; severe hypertension (diastolic BP \> 100 on medication)\]
•5. Cerebrovascular disease (e.g. CVA within 6 months), history of intracranial hemorrhage or intracranial aneurysms requiring treatment or arterial venous malformations (AVMs) requiring treatment
•6. Untreated, uncontrolled sleep apnea
•7. Patients with brain tumors, epilepsy, neurodegenerative disease or any other major neurological disorder
•8. Patients with standard contraindications for MR imaging such as non-MRI compatible implanted metallic devices including cardiac pacemakers, size limitations, etc.
•9. Known intolerance or allergies to MRI contrast agent (e.g. Gadolinium or Magnevist) including advanced kidney disease
•10. Subjects who weigh more than the upper weight limit of the MR scanner table and who cannot fit into the MR scanner
+10 more criteria

Locations (2)

Stanford University

Palo Alto, California, United States

Brigham and Women's Hospital

Boston, Massachusetts, United States

Key Dates

Start Date

August 1, 2026

Primary Completion Date

August 1, 2030

Completion Date

August 1, 2032

Last Updated

February 25, 2026

Enrollment

ESTIMATED participants

Conditions

Obsessive-Compulsive Disorder

Interventions

ExAblate MR-guided Focused Ultrasound Bilateral Anterior Capsulotomy

DEVICE

Acceptance and Commitment Therapy for Religious OCD

NCT06647589

Obsessive-Compulsive Disorder (OCD)

View study

RECRUITING

University of Iowa Interventional Psychiatry Service Patient Registry

NCT04480918

Treatment Resistant DepressionMajor Depressive Episode+5 more

View study

RECRUITING

Data Source & Attribution

This clinical trial information is sourced from ClinicalTrials.gov, a service of the U.S. National Institutes of Health.

ClinicalTrials.gov last update: February 25, 2026Data synced to Clareo: March 29, 2026

Modifications: This data has been reformatted for display purposes. Eligibility criteria have been parsed into inclusion/exclusion sections. Location data has been geocoded to enable distance-based search. For the authoritative and most current information, please visit ClinicalTrials.gov.

Neither the United States Government nor Clareo Health make any warranties regarding the data. Check ClinicalTrials.gov frequently for updates.

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Sonication-based OCD Neurosurgical Intervention Via Capsulotomy

Inclusion Criteria

Exclusion Criteria

Acceptance and Commitment Therapy for Religious OCD

University of Iowa Interventional Psychiatry Service Patient Registry

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Virtual Reality Exposure Therapy for Obsessive-Compulsive Disorder: A Randomized Controlled Trial in Inpatients

Brief Culturally Adapted CBT for OCD

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