[Surgical treatment of patients with therapy-resistant obsessive-compulsive disorder. Review]

In spite of adequate pharmaco- and psychotherapy, only 60-80 percent of the patients with obsessive compulsive disorder (OCD) respond to treatment and the symptoms of OCD will persist in 20-40 percent of the cases. These patients are considered therapy resistant. Neurosurgical procedures may bring a breakthrough for patients with OCD, especially in therapy resistant OCD and the burden of the illness can be reduced. The theoretical background of these procedures is based on the new biological theories of OCD. Here we summarise the loop theories and describe the four different types of irreversible neurosurgical techniques used in OCD (cingulotomy, subcaudate tractotomy, limbic leucotomy and anterior capsulotomy). We will review the reversible neurosurgical techniques (deep brain stimulation), as well. Two techniques, namely anterior capsulotomy and deep brain stimulation will be discussed in greater detail. Finally, we review the results of neuropsychological and personality changes associated with anterior capsulotomy.