Surgery can aid patients with severe obsessive-compulsive disorder

NEW YORK (Reuters Health) – Cingulotomy may help some patients with severe obsessive-compulsive disorder (OCD) who fail to respond to medication or behavioral therapy, according to Boston researchers.

A "small fraction" of patients with especially severe OCD, who do not respond to drug therapy, could be candidates for brain surgery, according to Dr. Darin D. Dougherty and colleagues at Massachusetts General Hospital and Harvard University in Boston.

They studied 44 OCD patients who were treated at their center with cingulotomy, in which electrodes were used to destroy small amounts of tissue in the cingulate gyrus.

Dr. Dougherty's team found that 45% of their patients had at least partial improvement after surgery. After an average of nearly 3 years, one third of the patients had responded to the treatment, and several others showed a partial response, according to findings published in the February issue of the American Journal of Psychiatry.

Based on questionnaires on patients' functioning–which measured things like sleeping habits, emotional well-being and social interaction–the study group improved overall, the researchers report.

Nine patients had at least one adverse effect, including temporary memory loss and urinary problems. One patient developed a seizure disorder that has required ongoing drug treatment, according to the researchers.

"As with any treatment," they write, "the potential benefits must be weighed against the associated potential risks." They suggest that further studies try to identify factors that predict whether a patient will do well after surgery.

The current evidence, they conclude, indicates that cingulotomy "remains a viable treatment option" for patients with severe OCD that has not responded to other therapy.

Am J Psychiatry 2002;159:269-275.

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