Stereotactic treatment of refractory obsessive compulsive disorder by bilateral capsulotomy with 3 years follow-up

Liu, Kangyong; Zhang, Haiyin; Liu, Chunfeng; Guan, Yihui; Lang, Liwei; Cheng, Yanbo; Sun, Bomin; Wang, Hui; Zuo, Chuantao; Pan, Li; Xu, Heding; Li, Shunjun; Shi, Lihua; Qian, Jinjun; Yang, Yaping

doi:10.1016/j.jocn.2007.07.086

Cited by 70 publications

(47 citation statements)

References 24 publications

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“…Of these, 10 studies included 108 patients with capsulotomy 5,7,8,17,23,26,28,32,37,41 and 10 included 62 patients who underwent DBS. 1,9,13,14,18,19,21,35,36,47 Table 1 (AC) and Table 2 (DBS) present details of the number of patients in each study, age at surgery, length of follow-up, details of the surgical procedures, and pre-and postoperative YBOCS scores.…”

Section: Resultsmentioning

confidence: 99%

“…In those who did respond, the largest treatment response was seen within the first 6 months, and this was maintained until the last follow-up. 7,17,26,28,32 However, Kondziolka et al recently reported on 3 patients who underwent AC who continued to experience improvements in YBOCS score up to a maximal follow-up of 55 months. 23 The published data seem to suggest that, for the most part, response to treatment is established within a relatively short time frame.…”

Section: Follow-up Durationmentioning

confidence: 99%

“…Some studies have used other scoring systems such as the global assessment of function in an attempt to measure these subjective outcomes. 13,18,23,26,28,32,37 Older, pre-YBOCS publications on AC for OCD often provided detailed clinical vignettes about whether the patients' functioning had improved; his or her return to work part-or full-time; impact on relationships; and so on. 20 These old reports provided a wealth of information that was certainly very pertinent to patients in their everyday life after surgery.…”

Section: The Ybocsmentioning

confidence: 99%

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Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Pepper

Hariz

Zrinzo

2015

JNS

101

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Obsessive-compulsive disorder (OCD) is a chronic and debilitating psychiatric condition. Traditionally, anterior capsulotomy (AC) was an established procedure for treatment of patients with refractory OCD. Over recent decades, deep brain stimulation (DBS) has gained popularity. In this paper the authors review the published literature and compare the outcome of AC and DBS targeting of the area of the ventral capsule/ventral striatum (VC/VS) and nucleus accumbens (NAcc). Patients in published cases were grouped according to whether they received AC or DBS and according to their preoperative scores on the Yale-Brown Obsessive-Compulsive Scale (YBOCS), and then separated according to outcome measures: remission (YBOCS score < 8); response (≥ 35% improvement in YBOCS score); nonresponse (< 35% improvement in YBOCS score); and unfavorable (i.e., worsening of the baseline YBOCS score). Twenty studies were identified reporting on 170 patients; 62 patients underwent DBS of the VC/VS or the NAcc (mean age 38 years, follow-up 19 months, baseline YBOCS score of 33), and 108 patients underwent AC (mean age 36 years, follow-up 61 months, baseline YBOCS score of 30). In patients treated with DBS there was a 40% decrease in YBOCS score, compared with a 51% decrease for those who underwent AC (p = 0.004). Patients who underwent AC were 9% more likely to go into remission than patients treated with DBS (p = 0.02). No difference in complication rates was noted. Anterior capsulotomy is an efficient procedure for refractory OCD. Deep brain stimulation in the VC/VS and NAcc area is an emerging and promising therapy. The current popularity of DBS over ablative surgery for OCD is not due to nonefficacy of AC, but possibly because DBS is perceived as more acceptable by clinicians and patients.

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Section: Resultsmentioning

confidence: 99%

Section: Follow-up Durationmentioning

confidence: 99%

Section: The Ybocsmentioning

confidence: 99%

See 1 more Smart Citation

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Pepper

Hariz

Zrinzo

2015

JNS

101

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“…deep-brain stimulation (DBS) 1,[6][7][8]12,18,22,23,31,51 for treatment-refractory OCD published in the last 10 years did not provide information on symptom dimensions, while 6 ablative 25,28 and DBS 14,20,21,54 studies described or commented on obsessive-compulsive symptom characteristics, and only 2 studies actively investigated the association of symptom dimensions with clinical outcome. 44,47 The first study, published by Rück and colleagues in 2012, 44 used an algorithm to calculate symptom dimensions based on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist (Y-BOCS-SC), 19 and reported that patients with prominent symmetry/order and/or hoarding symptoms were less likely to benefit from anterior capsulotomy.…”

mentioning

confidence: 99%

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

Gentil

Lopes

Dougherty

et al. 2014

JNS

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Object Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%–41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

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“…This lesion, whether made by heat (thermocoagulation during neurosurgery or a thermocapsulotomy) or by minimally invasive gamma irradiation (a gamma-capsulotomy), interrupts the passage of white matter fibers between the prefrontal cortex and the subcortical nuclei, the striatum, and the dorsomedial thalamus. A recent prospective study of 35 patients with obsessive-compulsive disorder who underwent thermocapsulotomy showed that that 70% had "satisfactory outcomes" after 3 years 66 .…”

Section: Evidence From Deep Brain Stimulation Researchmentioning

confidence: 99%

Advances in Neuromodulation: The Orbitofrontal-Striatal Model Of, and Deep Brain Stimulation In, Obsessive-Compulsive Disorder

McClure¹

2012

When Things Go Wrong - Diseases and Disorders of the Human Brain

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Stereotactic treatment of refractory obsessive compulsive disorder by bilateral capsulotomy with 3 years follow-up

Cited by 70 publications

References 24 publications

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

Advances in Neuromodulation: The Orbitofrontal-Striatal Model Of, and Deep Brain Stimulation In, Obsessive-Compulsive Disorder

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