Surgical Treatment in Intractable Obessive-Compulsive Disorder: Anterior Capsulotomy

Abstract

Objective: Obsessive–compulsive disorder (OCD) is an anxiety disorder characterized with recurrent intrusive thoughts (obsessions) and repetitive behaviours (compulsions). Although pharmacotherapy, behavioural therapy and electroconvulsive therapy are mainstays of OCD therapy, up to 30% of OCD patients fail to respond to these modalities. In patients with severe intractable OCD surgery is an option. We present two cases of severe OCD treated with bilateral anterior thermocapsulotomy.

Methods: Two patients, both of whom had unsuccessfully undergone long term pharmacotherapy, behavioural therapy and electroconvulsive therapy and whose SCID-I evaluations showed OCD and major depression underwent bilateral anterior thermocapsulotomy. Postoperatively Yale-Brown obsessive compulsive score dropped to 15 in one patient and to 5 in the other out of a possible 40, and no neuropsychological deterioration was observed in either patient.

Conclusion: Two cases of treatment resistant OCD that underwent anterior capsulotomy are presented, and surgical indications and clinical protocol are evaluated. Good results obtained in these cases corroborate findings of a literature review, demonstrating that anterior capsulotomy can provide relief in OCD.