1 Neurosurgery for severe OCD: the past, present and future

2021 ◽  
Vol 92 (8) ◽  
pp. A1.1-A1
Author(s):  
Eileen Joyce
Keyword(s):  
Electrode Placement ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Prevention Therapy ◽  
Optimal Target ◽  
Near Future ◽  
Anterior Capsulotomy ◽  
Deep Brain

Obsessive compulsive disorder (OCD) is a common disorder thought to have a prevalence of 1-2%. The majority of patients are helped by treatments such as exposure and response prevention therapy and medication. A significant minority fail to benefit from optimal treatment and are severely disabled with respect to everyday function.Such patients may be candidates for a neurosurgical approach. This talk will trace the development of neurosurgery for severe OCD beginning with leucotomy/lobotomy which was practiced in the early part of the 20th Century and left an unfavourable legacy. Advancements in neurosurgery have allowed techniques such as anterior cingulotomy and anterior capsulotomy to be practiced at present and will be compared. Deep brain stimulation for severe OCD was introduced as an alternative to ablation neurosurgery but the optimal target for electrode placement remains under debate and will be discussed with reference to a study directly comparing DBS of two emerging targets within the same patients. Finally, methods of target refinement will be discussed which may improve patients outcome in the near future.

Overview of the Treatment of OCD

2017 ◽  
Author(s):  
H. Blair Simpson
Keyword(s):  
Behavioral Therapy ◽  
Treatment Algorithm ◽  
Treatment Strategies ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Acceptance And Commitment ◽  
Prevention Therapy ◽  
Augmentation Strategies ◽  
Clinical Considerations

Obsessive-Compulsive Disorder (OCD) is a chronic and disabling disorder with a lifetime prevalence of 2% to 3%. This chapter briefly introduces the different treatment strategies for OCD and provides a treatment algorithm for use in clinical practice. It discusses aspects of cognitive-behavioral therapy (CBT), including variants such as exposure and response prevention therapy (ERP), and acceptance and commitment therapy (ACT), as well as clinical considerations. It also covers pharmacotherapy for OCD, including serotonin reuptake inhibitors (SRIs) and various augmentation strategies for them such as CBT and antipsychotics. There are sections addressing treatment of children and adolescents, and other treatments for OCD such as transcranial magnetic stimulation (TMS) or surgery. Subsequent chapters review these different treatment strategies in more detail and are referred to throughout this chapter.

Deep brain stimulation and anterior capsulotomy: The question of autonomy

2017 ◽  
Vol 41 (S1) ◽  
pp. S323-S323
Author(s):  
S. Raymaekers ◽  
Z. Van Duppen ◽  
K. Demyttenaere ◽  
L. Luyten ◽  
L. Gabriels ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Well Being ◽  
Structured Interviews ◽  
Obsessive Compulsive ◽  
Research Education ◽  
Compulsive Disorder ◽  
The Brain ◽  
Anterior Capsulotomy ◽  
Deep Brain

IntroductionIn carefully selected treatment-refractory patients with obsessive compulsive disorder (OCD), deep brain stimulation (DBS) or anterior capsulotomy (AC) might be considered as a possible treatment. However, the direct intervention in the brain can raise questions about autonomy. Do patients still feel like they are in control of their actions when their behavior is changed by a surgical intervention?Objective/aimsTo examine in both AC and DBS patients whether these intervention influenced perception of autonomy. We aimed to discover any differences in these perceptions when comparing AC and DBS patients.MethodsWe conducted semi-structured interviews with AC and DBS patients. Interviews were recorded digitally and transcribed verbatim. We analyzed interviews in an iterative process based on grounded theory principles.ResultsWe interviewed 10 DBS patients and 6 AC patients. Sense of agency (the awareness that one is the author of his/her own actions) did not seem to be diminished by AC or DBS. However, especially DBS patients are aware of their dependency on a device for their well-being. Another important theme is authenticity (in how far patients perceive their actions and thoughts as matching their self-concept). Feelings of authenticity can be disturbed especially in cases of induced hypomania (for DBS) or apathy (for AC). OCD itself also has an impact on autonomy as patients describe a lack of freedom due to their disorder.ConclusionDespite extensive changes in emotions, behavior and even personal identity after DBS or AC surgery, perceived autonomy was not greatly altered in these OCD patients.Disclosure of interestMedtronic provided grants for research, education, and traveling to B. Nuttin and L. Gabriëls, who hold the Medtronic Chair for Stereotactic Neurosurgery in Psychiatric Disorders at KU Leuven. S. Raymaekers is supported by this Chair. B. Nuttin co-owns a patent on DBS in OCD.

Magnetic Resonance-Guided Focused Ultrasound Capsulotomy for Treatment-Resistant Psychiatric Disorders

2020 ◽  
Author(s):  
Benjamin Davidson ◽  
Clement Hamani ◽  
Yuexi Huang ◽  
Ryan M Jones ◽  
Ying Meng ◽  
...  
Keyword(s):  
Focused Ultrasound ◽  
Invasive Technique ◽  
Treatment Resistant ◽  
Obsessive Compulsive ◽  
Refractory Depression ◽  
Compulsive Disorder ◽  
Psychiatric Surgery ◽  
Anterior Capsulotomy ◽  
Deep Brain

Abstract BACKGROUND Psychiatric surgery is an important domain of functional neurosurgery and involves deep brain stimulation (DBS) or lesional procedures performed for treatment-resistant psychiatric illness. It has recently become possible to use magnetic-guided focused ultrasound (MRgFUS) to perform bilateral capsulotomy, a lesional technique commonly carried out with surgical radiofrequency ablation or stereotactic radiosurgery. MRgFUS offers several advantages, including improved safety and real-time imaging of the lesions. OBJECTIVE To describe the clinical and technical aspects of performing bilateral MRgFUS capsulotomy in patients with severe refractory depression and obsessive-compulsive disorder. METHODS We describe the clinical and technical considerations of performing MRgFUS capsulotomy. Topics discussed include patient selection, headframe application, targeting, sonication strategies, and follow-up procedures. RESULTS MRgFUS capsulotomy was performed in 16 patients without serious clinical or radiographic adverse events. CONCLUSION MRgFUS allows for a safe, less invasive technique for performing a well-studied psychiatric surgery procedure—the anterior capsulotomy.

scholarly journals Anterior capsulotomy for obsessive-compulsive disorder: a review of old and new literature

2020 ◽  
Vol 133 (5) ◽  
pp. 1595-1604 ◽  
Author(s):  
Joshua Pepper ◽  
Ludvic Zrinzo ◽  
Marwan Hariz
Keyword(s):  
Clinical Response ◽  
Obsessive Compulsive Disorder ◽  
Clinical Effectiveness ◽  
Multidisciplinary Teams ◽  
Neurosurgical Procedures ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
New Literature ◽  
Anterior Capsulotomy ◽  
Deep Brain

Over the last two decades, deep brain stimulation (DBS) has gained popularity as a treatment of severe and medically refractory obsessive-compulsive disorder (OCD), often using brain targets informed by historical lesional neurosurgical procedures. Paradoxically, the use of DBS in OCD has led some multidisciplinary teams to revisit the use of lesional procedures, especially anterior capsulotomy (AC), although significant aversion still exists toward the use of lesional neurosurgery for psychiatric disorders. This paper aims to review all literature on the use of AC for OCD to examine its effectiveness and safety profile.All publications on AC for OCD were searched. In total 512 patients were identified in 25 publications spanning 1961–2018. In papers where a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was available, 73% of patients had a clinical response (i.e., > 35% improvement in Y-BOCS score) and 24% patients went into remission (Y-BOCS score < 8). In the older publications, published when the Y-BOCS was not yet available, 90% of patients were deemed to have had a significant clinical response and 39% of patients were considered symptom free. The rate of serious complications was low.In summary, AC is a safe, well-tolerated, and efficacious therapy. Its underuse is likely a result of historical prejudice rather than lack of clinical effectiveness.

scholarly journals Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

2015 ◽  
Vol 122 (5) ◽  
pp. 1028-1037 ◽  
Author(s):  
Joshua Pepper ◽  
Marwan Hariz ◽  
Ludvic Zrinzo
Keyword(s):  
Deep Brain Stimulation ◽  
Obsessive Compulsive Disorder ◽  
Brain Stimulation ◽  
Complication Rates ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Ablative Surgery ◽  
Anterior Capsulotomy ◽  
Deep Brain

Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition. Traditionally, anterior capsulotomy (AC) was an established procedure for treatment of patients with refractory OCD. Over recent decades, deep brain stimulation (DBS) has gained popularity. In this paper the authors review the published literature and compare the outcome of AC and DBS targeting of the area of the ventral capsule/ventral striatum (VC/VS) and nucleus accumbens (NAcc). Patients in published cases were grouped according to whether they received AC or DBS and according to their preoperative scores on the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and then separated according to outcome measures: remission (YBOCS score < 8); response (≥ 35% improvement in YBOCS score); nonresponse (< 35% improvement in YBOCS score); and unfavorable (i.e., worsening of the baseline YBOCS score). Twenty studies were identified reporting on 170 patients; 62 patients underwent DBS of the VC/VS or the NAcc (mean age 38 years, follow-up 19 months, baseline YBOCS score of 33), and 108 patients underwent AC (mean age 36 years, follow-up 61 months, baseline YBOCS score of 30). In patients treated with DBS there was a 40% decrease in YBOCS score, compared with a 51% decrease for those who underwent AC (p = 0.004). Patients who underwent AC were 9% more likely to go into remission than patients treated with DBS (p = 0.02). No difference in complication rates was noted. Anterior capsulotomy is an efficient procedure for refractory OCD. Deep brain stimulation in the VC/VS and NAcc area is an emerging and promising therapy. The current popularity of DBS over ablative surgery for OCD is not due to nonefficacy of AC, but possibly because DBS is perceived as more acceptable by clinicians and patients.

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