Steven Dubovsky, MD

A small study shows benefit for some patients with intractable obsessive-compulsive disorder.

Deep brain stimulation at various locations is approved for the treatment of highly refractory obsessive-compulsive disorder (OCD). Researchers in Brazil examined the benefit of an alternative surgical approach, gamma-knife lesioning of the internal capsule.

The 16 participants had OCD that had failed to respond to multiple serotonin reuptake inhibitors and cognitive-behavior therapy. Patients were randomized to active or simulated bilateral ventral gamma-knife capsulotomy.

During the blinded, first postoperative year, three of eight patients who received active surgery and none in the sham group showed response (≥35% improvement in OCD rating scale scores). Mean OCD-symptom scores were significantly lower in the active-treatment group than in the sham group.

After blinding ended, patients who received sham treatment were offered real surgery, accepted by four patients. During the total follow-up (mean, 55 months), response occurred in two of these patients, and two more active-treatment patients also responded, for an overall 58% response rate. Of the patients who never received active surgery, none responded.

Citation(s):

Lopes AC et al. Gamma ventral capsulotomy for obsessive-compulsive disorder: A randomized clinical trial. JAMA Psychiatry 2014 Jul 23; [e-pub ahead of print].