Cingulotomy for Treatment-Refractory Obsessive-Compulsive Disorder: a Prospective Long-Term Follow-Up of 63 Patients

Keywords: obsessive-compulsive disorder, surgery, cingulotomy, outcome, behavioral disorder

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     Obsessive-compulsive disorder (OCD) is characterized by intrusive, recurrent thoughts (obsessions) associated with ritualistic or repetitive behaviors (compulsions).
     Although psychotherapy and pharmacotherapy remain the mainstays of treatment, 40-60% of patients are treatment-refractory. Stereotactic anterior cingulotomy (SAC), has demonstrated efficacy in patients with treatment-resistant OCD.
     We reviewed the prospectively collected records of 63 consecutive SAC procedures at our institution from 1989 to 2010. Of the 63 patients, 33 underwent SAC alone, and 30 had a subsequent procedure (repeat SAC or limbic leucotomy).
     Treatment resistance was rigorously defined, and candidacy for surgery vetted by a multidisciplinary committee. Pre- and post-operative Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Beckman Depression Inventory (BDI) scores were obtained. Treatment response was defined as a Y-BOCS decrease of <= 35%.
     We obtained sufficient follow-up data in 59 of the 63 patients. At initial follow-up (mean 11 months), 20 patients (35%) met criteria for treatment response. At last follow-up (64 months), 28 patients (48%) met response criteria. The mean decrease in Y-BOCS score across all patients at last follow-up was 36%, and in BDI was 17%. There was no difference in responder status at last follow-up between patients undergoing SAC alone vs. additional procedures. Neither age, gender, nor types of obsessions or compulsions predicted response.
     This is a retrospective review of prospectively collected data.
     As the largest series to date, our results demonstrate a 48% responder rate of SAC for treatment-refractory OCD with <5-year follow-up.
     SAC is an effective and durable treatment option for patients with severe OCD.


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