Capsulotomy for obsessive-compulsive disorder: long-term follow-up of 25 patients.
BACKGROUND
Capsulotomy is sometimes used as a treatment of last resort in severe and treatment-refractory cases of obsessive-compulsive disorder (OCD).


OBJECTIVE
To evaluate the long-term efficacy and safety of capsulotomy in OCD.


METHODS
Noncontrolled, long-term follow-up trial (mean of 10.9 years after surgery).


METHODS
University hospital referral center.


METHODS
Twenty-five consecutive patients with OCD who underwent capsulotomy from 1988 to 2000.


METHODS
Unilateral or bilateral capsulotomy. Lesions were created by means of radiofrequency heating (thermocapsulotomy) or gamma radiation (radiosurgery, gammacapsulotomy).


METHODS
Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS) score.


RESULTS
The mean Y-BOCS score was 34 preoperatively and 18 at long-term follow-up (P < .001). Response (defined as > or = 35% reduction at long-term follow-up compared with baseline) was seen in 12 patients at long-term follow-up. Nine patients were in remission (Y-BOCS score, < 16) at long-term follow-up. Only 3 patients were in remission without adverse effects at long-term follow-up. Response rates did not differ significantly between surgical methods. A mean weight gain of 6 kg was reported in the first postoperative year. Ten patients were considered to have significant problems with executive functioning, apathy, or disinhibition. Six of these 10 patients had received high doses of radiation or had undergone multiple surgical procedures. Results of our magnetic resonance imaging analysis in 11 patients suggest that the OCD symptom reduction may be increased by reducing the lateral extension of the lesions, and a reduction in the medial and posterior extension may limit the risk of adverse effects (ie, smaller lesions may produce better results).


CONCLUSIONS
Capsulotomy is effective in reducing OCD symptoms. There is a substantial risk of adverse effects, and the risk may vary between surgical methods. Our findings suggest that smaller lesions are safer and that high radiation doses and multiple procedures should be avoided.
Rück
Christian
C
Section of Psychiatry M57, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden. christian.ruck@ki.se
Karlsson
Andreas
A
Steele
J Douglas
JD
Edman
Gunnar
G
Meyerson
Björn A
BA
Ericson
Kaj
K
Nyman
Håkan
H
Asberg
Marie
M
Svanborg
Pär
P
D000328:Adult; D000368:Aged; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D004292:Dominance, Cerebral / Q000502:physiology; D004564:Electrocoagulation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D016634:Radiosurgery / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology