TUESDAY, April 17 (HealthDay News) -- Most people with
obsessive-compulsive disorder manage their symptoms through talk
therapy and medication. But for some, severe OCD can take over
their lives. A few eventually turn to brain surgery, and a new
study shows how they fared.
The study included 63 adult patients who underwent "stereotactic
anterior cingulotomy" at Massachusetts General Hospital from 1989
to 2010, with long-term data available for 59 of the cases.
"Half these patients had a very significant improvement in their symptoms -- more than 35 percent improvement in the OCD scale that we use," said Dr. Sameer Sheth, chief resident in the department of neurosurgery at the hospital.
"These are patients who are completely refractory (unresponsive) to medical or behavioral therapy and have gone for years, if not decades, completely incapacitated," he added.
Patients who responded "are often still taking their medications
and they're still undergoing behavioral therapy, but it's actually
making a difference," Sheth said. "They're able to stop the hand
washing, stop the checking, stop the hoarding, all these symptoms
they had before, and carry on with their lives."
He was scheduled to present the research Tuesday at the American
Association of Neurological Surgeons' annual meeting, in Miami.
People with obsessive-compulsive disorder have recurrent,
upsetting thoughts that lead them to perform repetitive behaviors
or rituals to try and relieve their anxiety. According to the U.S.
National Institute of Mental Health, one in 100 adults in the
United States has obsessive-compulsive disorder, and half are
Obsessive-compulsive disorder symptoms in severe cases "can take
over the entire day," said Kiara Timpano, an assistant professor in
the department of psychology at the University of Miami who works
with patients with OCD.
"With a hand-washing or showering obsession, a person could take up to six hours a day, doing their washing ritual. That's just torture," Timpano added.
Frontline psychological treatment for obsessive-compulsive
disorder is called exposure therapy. Medications include selective
serotonin reuptake inhibitors (SSRIs). Estimates vary, but for a
quarter or more of patients, these therapies don't work.
Neurosurgical options include gamma-knife surgery and deep brain
stimulation, as well as cingulotomy. But potential candidates for
these options must undergo a rigorous screening, Sheth said.
Both experts emphasized that the surgical candidates in the
study had failed rounds of single- and multiple-drug therapies as
well as behavioral therapies and were vetted by a multidisciplinary
Most patients who do undergo a cingulotomy don't experience any
complications, Sheth said. In his study, he reported, three
developed abulia -- a difficulty in interacting and
unresponsiveness -- lasting a few days; one patient developed
seizures that required medication, and another had an
In addition, he said, two patients committed suicide at some
point after undergoing the procedure. One occurred a few weeks
after the surgery, and the other about a year later. He noted that
along with obsessive-compulsiveness, patients are monitored for
"These patients with this severe OCD often have [co-existing] depression, major depression," he said. "So in a group of moderately to severely depressed patients over a 20-year time span, two out of the 63 is probably a similar fraction to what you'd expect."
The research is ongoing, Sheth added, with the team keeping
track of these patients -- who come from all over the world --
And Timpano noted, "I think it's important that they've
demonstrated this follow-up on a fairly large group of patients. It
really lets us see how people who've received the cingulotomy do in
the long run."
Sheth's team reported on results to date in the
American Journal of Psychiatry in 2002, and the current
results are under review for journal publication. Findings
presented at medical meetings are typically considered preliminary
until published in a peer-reviewed journal.
The International OCD Foundation has more about
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Copyright © EBSCO Publishing. All rights reserved.