[Update on neurosurgical treatment for obsessive compulsive disorder].
Responses to pharmacotherapy and psychotherapy in obsessive-compulsive disorder (OCD) range from 60 to 80% of cases. However, a subset of OCD patients do not respond to adequately conducted treatment trials, leading to severe psychosocial impairment. Stereotactic surgery can be indicated then as the last resource. Five surgical techniques are available, with the following rates of global post-operative improvement: anterior capsulotomy (38-100%); anterior cingulotomy (27-57%); subcaudate tractotomy (33-67%); limbic leucotomy (61-69%), and central lateral thalamotomy/anterior medial pallidotomy (62.5%). The first technique can be conducted as a standard neurosurgery, as radiosurgery or as deep brain stimulation. In the standard neurosurgery neural circuits are interrupted by radiofrequency. In radiosurgery, an actinic lesion is provoked without opening the brain. Deep brain stimulation consists on implanting electrodes which are activated by stimulators. Literature reports a relatively low prevalence of adverse events and complications. Neuropsychological and personality changes are rarely reported. However, there is a lack of randomized controlled trials to prove efficacy and adverse events/complication issues among these surgical procedures. Concluding, there is a recent development in the neurosurgeries for severe psychiatric disorders in the direction of making them more efficacious and safer. These surgeries, when correctly indicated, can profoundly alleviate the suffering of severe OCD patients.
Lopes
Antonio Carlos
AC
Projeto Transtorno do Espectro Obsessivo-Compulsivo, Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. antonioclopes@uol.com.br
de Mathis
Maria Eugênia
ME
Canteras
Miguel Montes
MM
Salvajoli
João Victor
JV
Del Porto
José Alberto
JA
Miguel
Eurípedes Constantino
EC
D006801:Humans; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D009771:Obsessive-Compulsive Disorder / Q000601:surgery*