Bilateral Anterior Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder.
Trevor Hurwitz1, Geoffrey Ching1, Nicholas Mark Bogod2
1Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Stereotactic and Functional Neurosurgery
|August 25, 2024
Summary
Bilateral anterior capsulotomy (BAC) is an effective last resort for treatment-resistant obsessive-compulsive disorder (TROCD), with sustained symptom reduction and no significant long-term side effects in a 20-year study.
Area of Science:
- Neurosurgery
- Psychiatry
- Neurology
Background:
- Ablative surgery, specifically bilateral anterior capsulotomy (BAC), serves as a final treatment option for severe, treatment-resistant obsessive-compulsive disorder (TROCD).
- Our center has utilized BAC for eligible patients for two decades, necessitating a review of long-term outcomes.
Purpose of the Study:
- To report the long-term efficacy and safety of bilateral anterior capsulotomy (BAC) in patients with treatment-resistant obsessive-compulsive disorder (TROCD).
- To evaluate sustained response rates and potential neurocognitive or physical side effects following BAC surgery.
Main Methods:
- Five patients with obsessive-compulsive disorder (OCD) meeting criteria for BAC underwent the procedure using stereotactic radiofrequency.
- Complex entry protocols were followed, and patients were monitored for 4 to 20 years post-surgery.
- Lesion sizes ranged from 5.7 to 16.9 mm in the coronal plane.
Main Results:
- All five patients (100%) achieved responder status, defined by a ≥35% reduction in Yale-Brown Obsessive Compulsive Scale (YBOCS) scores at 18 months.
- Symptom reduction was sustained in four patients at 48 months, with one relapse occurring 19 years post-surgery after medication discontinuation.
- No significant long-term neurocognitive or physical side effects were observed; however, real-world psychiatric outcomes varied.
Conclusions:
- Bilateral anterior capsulotomy (BAC) should be maintained as a viable last resort option for severe OCD cases unresponsive to other treatments.
- The procedure demonstrates long-term efficacy and a favorable safety profile for carefully selected patients.
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