title: Limbic system surgery for treatment-refractory obsessive-compulsive disorder: a prospective long-term follow-up of 64 patients.
abstract: OBJECTIVE
  Obsessive-compulsive disorder (OCD) is a common and disabling psychiatric illness, and in a significant proportion of patients with OCD the disease is refractory to conventional pharmacotherapy and psychotherapy. For more than half a century, patients with severe, treatment-resistant OCD have been treated with stereotactic limbic system lesions, including dorsal anterior cingulotomy. The authors present their results describing the efficacy and durability of limbic system surgery for OCD, characterizing a large cohort of patients treated at a single institution with a mean follow-up of more than 5 years.
  
  
  METHODS
  The authors identified 64 consecutive patients undergoing cingulotomy for refractory OCD at the Massachusetts General Hospital between 1989 and 2009. Changes in OCD and major depressive disorder symptom severity were assessed at both the initial and most recent postoperative follow-up by using the Yale-Brown Obsessive Compulsive Scale and the Beck Depression Inventory, respectively. Full and partial OCD symptom responses were defined as Yale-Brown Obsessive Compulsive Scale score reductions of ≥ 35% and 25%-34%, respectively.
  
  
  RESULTS
  Regarding OCD symptom improvement, at the first postoperative follow-up (mean 10.7 months), 35% of patients demonstrated a full response and 7% were partial responders. Thirty patients had a subsequent procedure (repeat cingulotomy or subcaudate tractotomy). By the most recent follow-up (mean 63.8 months), rates climbed to 47% and 22% for full and partial responses, respectively. Of the 24 patients with at least a partial response at initial follow-up, 20 (83%) retained at least a partial response at final follow-up. Comorbid major depressive disorder severity decreased by 17% at the most recent follow-up.
  
  
  CONCLUSIONS
  Limbic system surgery based on initial cingulotomy offers a durable and effective treatment option for appropriately selected patients with severe OCD who have not responded to conventional pharmacotherapy or psychotherapy.
authors.affiliation: Departments of Neurosurgery, Massachusetts General Hospital, Boston, MA 02114, USA. sasheth@partners.org
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Sheth
authors.forename: Jonathan
authors.initials: J
authors.lastname: Neal
authors.forename: Frances
authors.initials: F
authors.lastname: Tangherlini
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Mian
authors.forename: Andre
authors.initials: A
authors.lastname: Gentil
authors.forename: G Rees
authors.initials: GR
authors.lastname: Cosgrove
authors.forename: Emad N
authors.initials: EN
authors.lastname: Eskandar
authors.forename: Darin D
authors.initials: DD
authors.lastname: Dougherty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008032:Limbic System / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery* / Q000628:therapy; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011612:Psychosurgery / Q000379:methods*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome