Bilateral Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorders

Oliver, B.; Gascón, Josep; Aparicio, A.; Ayats, Emilio; Rodríguez, R. Fuentes; León, Juan Luis Maestro de; García-Bach, Marcel; Soler, Pere Anton

doi:10.1159/000075110

Cited by 84 publications

(46 citation statements)

References 6 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%

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

Pepper

Hariz

Zrinzo

2015

JNS

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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%

“…One hundred patients were classified as having extreme OCD (YBOCS score of [32][33][34][35][36][37][38][39][40]. A similar rate of clinically significant response was achieved after AC and DBS (49% vs 52%, not significant).…”

Section: Resultsmentioning

confidence: 99%

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

Pepper

Hariz

Zrinzo

2015

JNS

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“…Although the molecular causes of OCD remain unsolved, a dysfunction in a neuronal loop running from the orbital frontal cortex to the cingulate gyrus, striatum (caudate nucleus and putamen), globus pallidus, thalamus, and back to the frontal cortex has been suggested. This hypothesis is supported by neurological (Laplane et al, 1989), neurosurgical (Mindus et al, 1994;Oliver et al, 2003;Rauch, 2003), and imaging findings (Baxter et al, 1992;Breiter et al, 1996;Saxena et al, 1998;Trivedi, 1996). The exact nature of the molecular events that evoke OCD symptoms is not known and several hypotheses have been put forward.…”

Section: Introductionmentioning

confidence: 90%

Fluvoxamine Treatment and D2 Receptors: a Pet Study on OCD Drug-Naïve Patients

Moresco

Pietra

Henin

et al. 2006

Neuropsychopharmacol

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Changes in D 2 receptors during antidepressant therapy have been reported in patients with major depressive disorder using PET/SPET. The aim of this study was to evaluate modifications in D 2 receptors that might occur in patients affected by obsessive-compulsive disorder (OCD) during serotonin reuptake sites inhibitors (SSRIs). To this purpose, we measured the in vivo binding of [ 11 C]raclopride ([ 11 C]Rac)in the brain of a group of OCD naïve patients before and after the repeated administration of the inhibitor SSRI fluvoxamine. Eight patients with a Diagnostic and Statistical Manual of Mental Disorders IVth edition diagnosis of OCD completed the study undergoing a PET scan and a complete clinical evaluation before and during treatment with fluvoxamine. Patients have been compared also with a group of nine age-matched normal volunteers. Fluvoxamine treatment significantly improved clinical symptoms and increased [ 11 C]Rac binding potential (BP) in the basal ganglia of OCD patients (7.575.2, 6.976.9, and 9.979.3% in dorsal caudate, dorsal putamen, and ventral basal ganglia, respectively; po0.01) to values closer to those observed in the group of normal subjects. Chronic treatment with fluvoxamine induces a slight but significant increase in striatal [ 11 C]Rac BP of previously drug-naïve OCD patients. The modifications in D 2 receptor availability might be secondary to fluvoxamine effects on serotoninergic activity.

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“…In severe OCD cases, where all other available therapeutic approaches have been tried without success, neurosurgery may be a treatment option. Only unblinded studies are available that showed improvements after Á bilateral anterior capsulotomy (Lippitz et al 1999; Ló pez Ibor and Ló pez-Ibor Aliñ o 1975; Mindus et al 1990Mindus et al , 1999Oliver et al 2003;Rü ck, 2006;Skoog and Skoog 1999), Á cingulotomy (Baer et al 1995;Dougherty et al 2002;Jenike et al 1991a;Kim et al 2003;Richter et al 2004), Á limbic leucotomy (Cumming et al 1995;Hay et al 1993;Montoya et al 2002;Sachdev and Hay 1995), Á subcaudate tractotomy (Hodgkiss et al 1995;Woerdeman et al 2006) or Á thalamotomy/pallidotomy (Jeanmonod et al 2003).…”

Section: Repetitive Transcranial Magnetic Stimulation (Rtms)mentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

696

401

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Bilateral Anterior Capsulotomy for Refractory Obsessive-Compulsive Disorders

Cited by 84 publications

References 6 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

Fluvoxamine Treatment and D2 Receptors: a Pet Study on OCD Drug-Naïve Patients

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

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