Capsulotomy for refractory anxiety disorders: long-term follow-up of 26 patients.
OBJECTIVE
The objective of the present study was to evaluate the long-term efficacy and safety of capsulotomy in patients with anxiety disorders.


METHODS
Twenty-six patients who had undergone bilateral thermocapsulotomy were followed up 1 year after the procedure and after a mean of 13 years. Primary diagnoses were generalized anxiety disorder (N=13), panic disorder (N=8), and social phobia (N=5). Measures of psychiatric status included symptom rating scales and neuropsychological testing. Ratings were done by psychiatrists not involved in patient selection or postoperative treatment. A quantitative magnetic resonance imaging (MRI) evaluation was conducted to search for common anatomic denominators. Seventeen of the 23 patients who were alive at long-term follow-up were followed up in person, and one was interviewed by telephone; the relatives of these 18 patients were interviewed.


RESULTS
The reduction in anxiety ratings was significant both at 1-year and long-term follow-up. Seven patients, however, were rated as having substantial adverse symptoms; the most prominent adverse symptoms were apathy and dysexecutive behavior. Neuropsychological performance was significantly worse in the patients with adverse symptoms. No common anatomic denominator could be found in responders in the analysis of MRI scans.


CONCLUSIONS
Thermocapsulotomy is an effective treatment for selected cases of nonobsessive anxiety but may carry a significant risk of adverse symptoms indicating impairment of frontal lobe functioning. These findings underscore the importance of face-to-face assessments of adverse symptoms.
Rück
Christian
C
Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institutet, Stockholm, Sweden. christianrueck@home.se
Andréewitch
Sergej
S
Flyckt
Karin
K
Edman
Gunnar
G
Nyman
Håkan
H
Meyerson
Björn A
BA
Lippitz
Bodo E
BE
Hindmarsh
Tomas
T
Svanborg
Pär
P
Mindus
Per
P
Asberg
Marie
M
D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000601:surgery*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D004564:Electrocoagulation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000601:surgery*; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016584:Panic Disorder / Q000175:diagnosis / Q000601:surgery; D010698:Phobic Disorders / Q000175:diagnosis / Q000601:surgery; D011569:Psychiatric Status Rating Scales; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome