Ablative neurosurgery and deep brain stimulation for obsessive-compulsive disorder.

Area of Science:

• Neurosurgery
• Psychiatry
• Neuroscience

Background:

• Many patients with obsessive-compulsive disorder (OCD) experience disabling, treatment-refractory illness despite current pharmacotherapeutic and behavioral interventions.
• Neurosurgical options, including ablative procedures and deep brain stimulation (DBS), are emerging as potential treatments for this patient group.

Purpose of the Study:

• To review contemporary neurosurgical options for obsessive-compulsive disorder (OCD).
• To focus on clinical aspects: patient selection, presurgical assessment, safety, and effectiveness of OCD surgeries.

Main Methods:

• Review of recent literature on neurosurgical interventions for OCD.
• Focus on clinical data regarding patient selection, assessment, safety, and efficacy.
• Analysis based on the corticostriatal model of OCD.

Main Results:

• Neurosurgical procedures are reserved for carefully selected patients with severe, chronic, treatment-refractory OCD.
• Both ablative procedures and DBS demonstrate benefit in approximately 50% of patients, with improvements noted months post-procedure.
• No definitive evidence supports one procedure over another; choice depends on cost, expertise, and reversibility.

Conclusions:

• Neurosurgery for OCD should be part of a comprehensive treatment plan, not a standalone therapy.
• Available evidence suggests benefits outweigh risks for refractory OCD patients.
• Advancements in neurosurgical techniques and neurobiology promise improved efficacy, safety, and acceptability.