title: Unilateral right anterior capsulotomy for refractory major depression with comorbid obsessive-compulsive disorder.
abstract: BACKGROUND
  Treatment-resistant major depression (MDD) and obsessive-compulsive disorder (OCD) remain a major cause of suffering and disability. These disorders may be treated with functional neurosurgery that almost always is bilateral but some patients might benefit from unilateral procedures.
  
  
  METHODS
  We performed a unilateral right anterior capsulotomy (AC) in a 45-year-old right-handed woman with MDD and comorbid OCD. This unilateral procedure was based on the results of neuropsychological testing and an 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) that revealed right hemisphere deficits in this patient.
  
  
  RESULTS
  Following surgery, Hamilton Depression scale (HAM-D) decreased 57% at 1 and 2 years and 54% at 3 years and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decreased 58% at 1 year, 77% at 2 years, and 96% at 3 years. There was a slight decrement of verbal memory and phonemic fluency after the procedure that could also be related to changes in medication. Right basal ganglia abnormalities revealed by FDG-PET remained unchanged 16 months postoperatively.
  
  
  CONCLUSIONS
  Overall this unilateral right AC was effective for the treatment of this woman's disorders with minimal adverse side effects.
authors: Neurology, Instituto Mexicano de Neurociencias, Huixquilucan, México. riestra@neurocienciasmexico.org
authors: Alonso R
authors: AR
authors: Riestra
authors: Jaime
authors: J
authors: Aguilar
authors: Gerardo
authors: G
authors: Zambito
authors: Gabriela
authors: G
authors: Galindo y Villa
authors: Fernando
authors: F
authors: Barrios
authors: Carla
authors: C
authors: García
authors: Kenneth M
authors: KM
authors: Heilman
mesh_terms: D003865:Major Depressive Disorder / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D061218:Depressive Disorder, Treatment-Resistant / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D011612:Psychosurgery / Q000379:methods*; D011877:Radionuclide Imaging