Lesion topography in capsulotomy for refractory anxiety--is the right side the right side?

A previous report on bilateral capsulotomy in obsessive-compulsive disorder showed common topographic features of lesions in the right-sided internal capsule in all patients responding to the treatment. The aims of the present study were to test if the same region was involved in anxiety patients responding to surgery and to examine whether lesion area and site correlated with adverse events and effect on target symptoms.

Eleven anxiety patients who had undergone bilateral thermocapsulotomy were examined after 8-23 years. A quantitative MRI evaluation of the lesions within the internal capsule was conducted in three axial planes.

None of the eight responders had lesions that corresponded to the earlier reported right-sided anatomical denominator. Four patients out of 11 were rated as having significant clinical symptoms indicating frontal lobe dysfunction. The total sum of the lesion area determined in each of the three anatomical levels did not correlate with the degree of anxiety reduction. However, the lesion area appeared to be related to a rating of executive dysfunctioning, apathy and disinhibition.