Surgery for OCD? Bilateral Anterior Capsulotomy Treats Obsessive Compulsive Disorder

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Home / Surgery for OCD? Bilateral Anterior Capsulotomy Treats Obsessive Compulsive Disorder

Medication and therapy can help most patients with OCD, but surgery is an option for those who are still suffering. Image by Lars Klintwall Malmqvist

Obsessive/Compulsive Disorder Surgery

For some patients with an OCD diagnosis, CBT and medication don’t work. Another treatment option, a brain surgery called bilateral anterior capsulotomy, is effective in persistent cases of OCD.  This surgery interrupts the circuitry in one area of the brain, and causes metabolic decreases in several brain regions. The metabolic changes are linked to clinical improvement and reduction of symptoms.

Although the surgery is rare, and carried out only when the OCD causes extreme distress, researchers have conducted several studies on its effectiveness.

  • One study found that more than 98% of people who had undergone the surgery showed improvement a month after the surgery. They showed decreased OCD symptoms, as well as improved functioning in their daily lives.
  • Another set of researchers performed a long-term follow-up study in 2008 on 25 patients who had undergone a bilateral anterior capsulotomy. When they interviewed the patients ten years post-surgery, they found that twelve were in remission, but others had adverse effects.

The latest research, published in June 2013, conducted by a group of Canadian scientists, found that surgery is an effective and safe technique when nothing else is able to relieve a case of OCD. They studied nineteen patients who had undergone bilateral capsulotomy between 1997 and 2009, then evaluated them at 3, 6, 9, 12 and 24 months after the surgery.

The researchers later contacted the patients at an average of seven years after the operation to review their progress. According to the results, almost half of the patients responded to the surgery, although not all of the patients gained full relief of OCD symptoms.  No one died as the result of the surgery, and only two had lasting surgical complications.

OCD Surgery: Safe, Effective Last Alternative

The 2013 study concluded that anterior capsulotomy is effect and safe for the treatment of severe refractory OCD, and recommend the operation only for patients who lack other alternatives to improve their symptoms. When a patient with OCD is completely unable to perform ordinary daily tasks, and medication and/or therapy have not helped, surgery may provide hope for recovery.

Sources

Zuo, C., et al. Metabolic imaging of bilateral anterior capsulotomy in refractory obsessive compulsive disorder: an FDG PET study. (2013). Journal of Cerebral Blood Flow & Metabolism. doi: 10.1038/jcbfm.2013.23 Accessed on June 9, 2013.

D’Astous, M., et al. Bilateral Stereotactic Anterior Capsulotomy for Obsessive-Compulsive Disorder: Long-term Follow-up. (2012). Journal of Neurology, Neurosurgery and Psychiatry. doi:10.1136/jnnp-2012-303826 Accessed on June 9, 2013.

Oliver, B., et al. Bilateral Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorders. (2003). Stereotactic and Functional Neurosurgery. Accessed on June 9, 2013.

Ruck, C., et al. Capsulotomy for Obsessive-Compulsive Disorder: Long-term Follow-up of Twenty Five Patients. (2008). Archives of General Psychiatry. doi: 10.1001/archpsyc.65.8.914. Accessed on June 9, 2013.

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