Capsulotomy for Obsessive-Compulsive Disorder : long term follow up of 25 patients

• Abstract Context: 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. Design: Non-controlled long-term follow-up trial (mean 10.9 years after surgery). Setting: University hospital referral center. Patients: 25 consecutive OCD patients having undergone capsulotomy between the years 1988 and 2000. Intervention: Unilateral or bilateral capsulotomy. Lesions were created either by conventional heating or by gamma-radiation (radiosurgery). Main Outcome Measure: Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS). Results: Mean Y-BOCS was 34 preoperatively and dropped to 18 at long-term follow-up (p<0.0001). Response (defined as ≥ 35 % reduction at long-term compared to baseline) was seen in 12 patients at long-term. Eight patients were in remission (Y-BOCS < 16) at long-term follow-up. Response rates did not differ between surgical method. A mean weight gain of 6 kg was reported in the first postoperative year. Ten patients were considered to sufferer from significant problems in the area of executive functioning, apathy or disinhibition. Six of these ten patients had either had high doses of radiation or multiple surgical procedures. Our MRI analysis of 11 patients suggests 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 side effects, that is, smaller lesions may produce better results. Conclusions: Capsulotomy is effective in reducing OCD symptoms. There is a substantial risk of side 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.

Ämnesord

SAMHÄLLSVETENSKAP  -- Psykologi (hsv//swe)

SOCIAL SCIENCES  -- Psychology (hsv//eng)

Nyckelord

capsulotomy

OCD

long term follow up

neuropsychology

Psychology

Psykologi

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