Surgery 'benefits patients with severe OCD'
Psychosurgery is an option for patients with severe obsessive compulsive disorder, shows one of the longest surgical treatment follow-up studies in these patients.
Canadian researchers looked at 19 patients with severe or extreme OCD who were treatment refractory and underwent a bilateral capsulotomy. Patients were assessed pre-surgery and at three, six, 12 and 24 months and last follow up (a mean of seven years after surgery). OCD symptom severity was evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), ranging on a scale from zero to 40. A patient with an improvement rate of ˃35% in the Y-BOCS score was considered a responder, while a patient with a 25% improvement was considered a partial responder.
Three of the 19 patients were rated as having severe OCD scoring ≥24 on the Y-BOCS scale, and the remaining 16 scored ≥32, placing them in the extreme OCD category. The mean improvement was 31% in the Y-BOCS scale, with 36.8% of patients fully responding to the procedure and 10.5% partially responding, giving an overall response rate of 47.3% of patients. Non-responding patients had a longer duration of illness at baseline than those with a better outcome. At the end of the study three had fully recovered (Y-BOCS score <8) and three were in remission (Y-BOCS score <16). The adverse event rate was 57.9% and mostly transient in nature. No cases of mortality were reported and two patients had permanent surgical complications.
What this means for GPs
The researchers concluded from their study that capsulotomy is a ‘safe procedure that can be considered with caution for patients with no other issues’ but note that ‘large-scale, controlled studies are needed to identify reliable predictors of treatment response and then optimise the risk/benefit ratio of this surgery’.