Anterior capsulotomy for obsessive-compulsive disorder: a review of old and new literature
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Over the last two decades, deep brain stimulation (DBS) has gained popularity as a treatment of severe and medically refractory obsessive-compulsive disorder (OCD), often using brain targets informed by historical lesional neurosurgical procedures. Paradoxically, the use of DBS in OCD has led some multidisciplinary teams to revisit the use of lesional procedures, especially anterior capsulotomy (AC), although significant aversion still exists toward the use of lesional neurosurgery for psychiatric disorders. This paper aims to review all literature on the use of AC for OCD to examine its effectiveness and safety profile.
All publications on AC for OCD were searched. In total 512 patients were identified in 25 publications spanning 1961–2018. In papers where a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score was available, 73% of patients had a clinical response (i.e., > 35% improvement in Y-BOCS score) and 24% patients went into remission (Y-BOCS score < 8). In the older publications, published when the Y-BOCS was not yet available, 90% of patients were deemed to have had a significant clinical response and 39% of patients were considered symptom free. The rate of serious complications was low.
In summary, AC is a safe, well-tolerated, and efficacious therapy. Its underuse is likely a result of historical prejudice rather than lack of clinical effectiveness.
ABBREVIATIONS
AC = anterior capsulotomy; DBS = deep brain stimulation; GK = Gamma Knife; ICH = intracerebral hemorrhage; NMD = neurosurgery for mental disorders; OCD = obsessive-compulsive disorder; SSRI = selective serotonin reuptake inhibitor; Y-BOCS = Yale-Brown Obsessive Compulsive Scale.Supplementary Materials
- Supplemental Tables 1-7 (PDF 497 KB)
Illustration from Nelson et al. (pp 1516–1526). Artists: Ethan Tyler, Erina He, and Alan Hoofring. Medical Arts, Office of Research Services, National Institutes of Health.
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