M A Jenike1. 1. Harvard Medical School, MA, USA. jenike@psych.mgh.harvard.edu
Abstract
BACKGROUND: Case reports suggest that neurosurgical operations can improve symptoms in patients with severe treatment-refractory obsessive-compulsive disorder (OCD). However, it is unclear which procedure is best and which may produce the most side-effects. METHOD: I review the literature on the efficacy and complications of four frequently used neurosurgical procedures (cingulotomy, capsulotomy, limbic leucotomy and subcaudate tractotomy) that are used to treat refractory OCD. RESULTS: Since the vast majority of patients who underwent surgery were severely and chronically disabled, it is likely that these procedures were of assistance in alleviating some of their symptoms. It is currently impossible to determine which surgical procedure is the best for a particular patient. CONCLUSIONS: Despite a lack of controlled data and inconsistencies in the literature, it appears that when non-surgical treatments have failed to improve OCD symptoms significantly in severely ill patients, at least partial relief can be obtained by some people with OCD by neurosurgery. Results of cumulative studies strongly support the need for continued research in this area.
BACKGROUND: Case reports suggest that neurosurgical operations can improve symptoms in patients with severe treatment-refractory obsessive-compulsive disorder (OCD). However, it is unclear which procedure is best and which may produce the most side-effects. METHOD: I review the literature on the efficacy and complications of four frequently used neurosurgical procedures (cingulotomy, capsulotomy, limbic leucotomy and subcaudate tractotomy) that are used to treat refractory OCD. RESULTS: Since the vast majority of patients who underwent surgery were severely and chronically disabled, it is likely that these procedures were of assistance in alleviating some of their symptoms. It is currently impossible to determine which surgical procedure is the best for a particular patient. CONCLUSIONS: Despite a lack of controlled data and inconsistencies in the literature, it appears that when non-surgical treatments have failed to improve OCD symptoms significantly in severely ill patients, at least partial relief can be obtained by some people with OCD by neurosurgery. Results of cumulative studies strongly support the need for continued research in this area.
Authors: Karen Blackmon; William B Barr; Chad Carlson; Orrin Devinsky; Jonathan DuBois; Daniel Pogash; Brian T Quinn; Ruben Kuzniecky; Eric Halgren; Thomas Thesen Journal: Psychiatry Res Date: 2011-07-30 Impact factor: 3.222
Authors: Jens Kuhn; Theo O J Gründler; Doris Lenartz; Volker Sturm; Joachim Klosterkötter; Wolfgang Huff Journal: Dtsch Arztebl Int Date: 2010-02-19 Impact factor: 5.594
Authors: Peter Rabins; Brian S Appleby; Jason Brandt; Mahlon R DeLong; Laura B Dunn; Loes Gabriëls; Benjamin D Greenberg; Suzanne N Haber; Paul E Holtzheimer; Zoltan Mari; Helen S Mayberg; Evelyn McCann; Sallie P Mink; Steven Rasmussen; Thomas E Schlaepfer; Dorothy E Vawter; Jerrold L Vitek; John Walkup; Debra J H Mathews Journal: Arch Gen Psychiatry Date: 2009-09
Authors: Edward D Huey; Roland Zahn; Frank Krueger; Jorge Moll; Dimitrios Kapogiannis; Eric M Wassermann; Jordan Grafman Journal: J Neuropsychiatry Clin Neurosci Date: 2008 Impact factor: 2.198