Neurosurgical treatment of obsessive-compulsive disorder.
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.


METHODS
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.
Jenike
M A
MA
Harvard Medical School, MA, USA. jenike@psych.mgh.harvard.edu
D003072:Cognition Disorders / Q000209:etiology; D003657:Decision Making; D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D009771:Obsessive-Compulsive Disorder / Q000601:surgery*; D018579:Patient Selection; D010554:Personality Disorders / Q000209:etiology; D011182:Postoperative Care; D012307:Risk Factors; D013405:Suicide