Anterior Capsulotomy for Treatment of Refractory Obsessive-Compulsive Disorder: Results in a Young and an Old Patient

Abstract

The objective of this case report was to assess the effect of anterior capsulotomy for obsessive-compulsive disorder (OCD) in 2 patients beyond extremes of age ranges of published radiofrequency capsulotomy. The youngest patient developed OCD at age 10 with increasing symptoms of tension and worry. The symptoms were refractory to medications and behavioral therapy. He underwent anterior capsulotomy at age 18. The older patient was 64 at the time of surgery. His OCD began about age 17 with checking and counting rituals. His obsessions extended into other areas such as fear of injuring people while driving. His work performance was greatly compromised. Despite medication trials his rituals and obsessions intensified. After 47 years of severe symptoms he underwent surgery. The youngest patient returned to high school full-time and graduated. He was able to read and comprehend without obsessing about the meaning of words. His thinking and behavior became symptom free and he married 4.5 years after surgery. His score on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) after surgery on no medication is zero. The older patient improved gradually without medication. He could play with and touch his grandchildren for the first time. He could drive a car again and his Y-BOCS dropped from 30 preoperatively to 8. Twenty-four months after surgery he is essentially free of obsessions, compulsions and anxiety. We conclude that treatment-refractory OCD may be alleviated by anterior radiofrequency capsulotomy in the young and the old patient. This study expands the documented age range of response from 18 to 64.

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

“…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.…”

Deep Brain Stimulation for Obsessive-Compulsive Disorder: Subthalamic Nucleus Target

“…Leukotomies combined cingulotomy and subcaudate tractotomy. Different centers worldwide have established the efficacy of such surgical treatments, which are still proposed in cases of intractable OCD (7,8,11,20,29). In the past decade, the use of deep brain stimulation (DBS) has progressively replaced lesions and Bart Nuttin and his team (25) were the first to apply the concept of high frequency stimulation of a deep target, the anterior limb of the internal capsule, to treat patients suffering from severe OCD.…”

Stereotactic lesions for the treatment of psychiatric disorders

“…Table 2 summarizes the procedural distribution for each disorder. [5][6][7][8][11][12][13][14][15]18,[21][22][23]25,26,28,29,[31][32][33]35,36,43,44,47,50,[52][53][54] Either the Mann-Whitney U-test or Kruskal-Wallis test was performed on each of these 7 disorder groups to determine if there was a statistically significant difference in the outcomes from the different anatomical targets.…”