NEUROSURGICAL TREATMENT OF OBSESSIVE-COMPULSIVE DISORDER

Background Case reports suggest that neurosurgical operations can impr ove symptoms in patients with severe treatment-refractory obsessive-co mpulsive disorder (OCD). However, it is unclear which procedure is bes t and which may produce the most side-effects. Method I review the lit erature on the efficacy and complications of four frequently used neur osurgical procedures (cingulotomy, capsulotomy, limbic leucotomy and s ubcaudate tractotomy) that are used to treat refractory OCD. Results S ince the vast majority or patients who underwent surgery were severely and chronically disabled, it is likely that these procedures were of assistance in alleviating some of their symptoms. It is currently impo ssible to determine which surgical procedure is the best for a particu lar patient. Conclusions Despite a lack of controlled data and inconsi stencies in the literature, it appears that when nonsurgical treatment s have failed to improve OCD symptoms significantly in severely iii pa tients, at least partial relief can be obtained by some people with OC D by neurosurgery. Results of cumulative studies strongly support the need for continued research in this area.