Psychosurgery for OCD: Some Respond in the Long Run

Jonathan Silver, MD

Some patients with obsessive-compulsive disorder improve significantly with psychosurgery, but it may have permanent and significant risks.

Many patients with obsessive-compulsive disorder (OCD) continue to experience severe symptoms even with medication or behavioral therapy. Various psychosurgical approaches have been used, but published studies on outcomes are few. In this single-center, longitudinal case series, researchers reported on 19 treatment-refractory OCD patients (12 women; mean age, 41) who had an anterior capsulotomy between 1997 and 2009.

The patients had undergone multiple trials of medications and therapy; symptoms lasted a mean of 16 years. The mean baseline severity score on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was 34.9, in the extreme range; patients showed some impairment in global functioning. Most patients had a coexisting psychiatric condition (mood disorder, 58%).The mean improvement in Y-BOCS score was 23% at 3 months and 31% at 24 months and long-term follow-up (mean, 7 years). At 7 years, seven patients met the criteria for “full response” (35% decrease in symptoms) — three “recovered” (Y-BOCS score <8), and three had mild symptoms. Responders had a shorter duration of symptoms than nonresponders, but similar comorbidities. The most common adverse consequence was “frontal syndrome” (5 patients). One patient had a permanent hemiplegia; another became cognitively impaired.

Citation(s):

D'Astous M et al. Bilateral stereotactic anterior capsulotomy for obsessive-compulsive disorder: Long-term follow-up. J Neurol Neurosurg Psychiatry 2013 Jun 3.