Surgical Methods for Treatment

Deep brain stimulation treatment: produced a global percentage of  Yale Brown obsessive compulsive scale(Y-BOCS) score reduction of 45.1% and a global percentage of responders of 60.0%. (Alonso, P. 2015).




Neurosurgery:

Although conventional behavioral and drug therapies are effective for treating most patients with obsessive-compulsive disorder (OCD), more than 10% of OCD patients remain incapacitated despite traditional ways to control it. In these cases neurosurgery plays a role in the treatment of the disorder. Deep brain stimulation (DBS) has been proposed as an alternative neurosurgery for severe treatment-resistant Obsessive-Compulsive Disorder (OCD), although with partially discrepant results probably related to differences in anatomical targeting and stimulation conditions. It’s an experimental neurosurgical treatment for OCD in which the brain is stimulated with electrical impulses. Deep brain stimulation is a technique that involves precise stimulation of particular parts of the brain through the implantation of removable electrodes. In a meta-analysis of treatment outcome and predictors of response, this alternative technique showed global percentage of Yale Brown obsessive compulsive scale (Y-BOC) reduction at 45.1% and global percentage of responders at 60.0%. Better response was associated with older age at OCD onset and presence of sexual/religious obsessions and compulsions. In this manner, DBS constitutes a valid alternative to lesional surgery for severe, therapy-refractory OCD patients. These results confirm that DBS appears to have an efficacy comparable to that reported for capsulotomy or cingulotomy that are going to be mentioned after this, ablative techniques after which 64% and 56% of patients respectively are rated as significantly improved. Studies analyzed, described these stimulation-related adverse effects as mild, transient and reversible after the adjustment of the stimulation. According to the results of this meta-analysis, the presence of sexual/religious obsessions and compulsions was associated with a significantly better response to DBS.

                                                                                

·         Cingulotomy: Study that combined anterior cingulotomy and DBS in Ventral capsule/ventral striatum. Combination did not yield superior outcomes. (Chang, W. 2013)

Cingulotomy is a form of psychosurgery introduced in 1948 as an alternative to lobotomy. Today it is mainly used in the treatment of depression and obsessive-compulsive disorder. It’s being hypothesized that the ventral capsule (VC), ventral striatum (VS), that make up the corticothalamic pathway and the cortex-striatum-thalamus-cortex (CSTC) loop and the anterior cingulate gyrus are parts of the obsessive compulsive disorder and depression circuits as mentioned earlier. In an experiment realized in 2013, investigators  assessed whether a combination of bilateral anterior cingulotomy and VC/VS deep brain stimulation (DBS) had an additive effect in patients with OCD and major depression because the targets of the two procedures are different and, therefore, may have additive effects. They analyzed the outcome of three patients with severe OCD resistant to traditional treatments that underwent combined bilateral anterior cingulotomy and VC/VS DBS procedures. The combination of the two therapies did not yield superior outcomes, as the clinical outcomes were comparable to those of previous reports for VC/VS DBS alone. Wide-area VC/VS DBS may be sufficient to control refractory OCD. Possible explanations states that a reason of this outcome may be because the inter-connections and relationships between the three different functional and anatomical circuits that are related to OCD and depression. Another reason may have been because of the extent of the stimulation.

·         Capsulotomy: When traditional methods to treat ocd fails, use of capsulotomy. Study that analyzed patients who had been treated with capsulotomy found that this method improve condition. Different scales used to diagnose ocd in study had significant differences. (Zhan, S. 2014)

Capsulotomy is a type of eye surgery in which an incision is made into the capsule of the crystalline lens of the eye. In modern operations for cataract, the lens capsule is usually not removed. For treatment-refractory OCD patients, bilateral anterior capsulotomy is a potential therapy. There has been shown in a study that bilateral capsulotomy is a precise therapy for refractory OCD, which can improve patients quality of life and restores their social function. In a review of all cases of capsulotomy previously reported in the literature, although there is no significant difference, indicate that anterior capsulotomy is more effective for the treatment of OCD than cingulotomy. But only very severe OCD cases should be chosen because of the risk of capsulotomy. DBS have fewer complications but it’s more expensive than capsulotomy due to the continuing costs of battery changes.