Magnetic resonance imaging-guided stereotactic limbic leukotomy for treatment of intractable psychiatric disease.
OBJECTIVE
To assess the efficacy and complication rates of magnetic resonance imaging-guided stereotactic limbic leukotomy for the treatment of intractable major depressive disorder (MDD) and obsessive-compulsive disorder (OCD).


METHODS
We conducted preoperative evaluations and postoperative follow-up assessments of efficacy and complications for 21 patients who underwent limbic leukotomy. Efficacy was based on physician- and patient-rated global assessments of functioning, as well as evaluations using disease-specific rating scales commonly used in studies of MDD and OCD.


RESULTS
The mean time from limbic leukotomy to follow-up assessment was 26 months. On the basis of standard outcome measures, 36 to 50% of patients were considered to be treatment responders. Although permanent surgical morbidity was rare, there were reports of postoperative sequelae, including apathy, urinary incontinence, and memory complaints, which occurred in a substantial minority of cases.


CONCLUSIONS
For this cohort of 21 patients with chronic severe MDD or OCD, who had experienced failure with an exhaustive array of previous treatments, limbic leukotomy was associated with substantial benefit for 36 to 50%. This rate is comparable to those of previous studies of limbic system surgery and indicates that limbic leukotomy is a feasible treatment option for severe, treatment-refractory MDD or OCD. Adverse consequences associated with the procedure included affective, cognitive, and visceromotor sequelae, which were generally transient.
Montoya
Alonso
A
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Weiss
Anthony P
AP
Price
Bruce H
BH
Cassem
Edwin H
EH
Dougherty
Darin D
DD
Nierenberg
Andrew A
AA
Rauch
Scott L
SL
Cosgrove
G Rees
GR
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000523:psychology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008032:Limbic System / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008569:Memory Disorders / Q000209:etiology; D008875:Middle Aged; D019964:Mood Disorders / Q000209:etiology; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000601:surgery*; D011612:Psychosurgery / Q000009:adverse effects; D013238:Stereotaxic Techniques; D025321:Surgery, Computer-Assisted; D013997:Time Factors; D014549:Urinary Incontinence / Q000209:etiology