Stereotactic Anterior Cingulotomy May Serve as an Effective Treatment Choice for Severe OCD Sufferers

Newswise — Miami (April 17, 2012) — Research findings presented today at the 80th Annual Scientific Meeting of the American Association of Neurological Surgeons (AANS) in Miami show that stereotactic anterior cingulotomy (SAC) may prove to be a viable treatment option for patients suffering from treatment-resistant obsessive-compulsive disorder (OCD).

The intrusive, habitual thoughts (obsessions) associated with the consistent, ceaseless behaviors (compulsions) characterize OCD, and while psychotherapy and pharmacotherapy continue to serve as the primary treatment methods, 40-60 percent of OCD patients are treatment-refractory. In the results of the study Cingulotomy for Treatment-Refractory Obsessive-Compulsive Disorder: a Prospective Long-Term Follow-Up of 63 Patients, researchers show SAC has demonstrated efficacy in patients with treatment-resistant OCD. Those results will be presented by Sameer A. Sheth, MD, PhD, 9:45-9:59 a.m., on Tuesday, April 17. Co-authors are Jonathan Neal; Matthew Mian, BSE; Frances Tangherlini, BS; Darin Dougherty, MD; G. Cosgrove, MD; and Emad Eskandar, MD.

The researchers reviewed the prospectively collected records of 63 consecutive SAC procedures at Massachusetts General Hospital from 1989-2010. Treatment resistance was rigorously defined, and candidacy for surgery was vetted by a multidisciplinary committee. Pre- and post-operative Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Beckman Depression Inventory (BDI) scores were obtained. Treatment response was defined as a Y-BOCS decrease of ≥ 35 percent.

Of the 63 patients, 33 underwent SAC alone, and 30 had a subsequent procdure (repeat SAC or limbic leucotomy). The researchers obtained sufficient follow-up data in 59 of the 63 patients. At the initial follow-up (a mean of 11 months), 20 patients (35 percent) met criteria for treatment response. At the final follow-up (64 months), 28 patients (48 percent) met response criteria. The mean decrease in Y-BOCS scores across all patients at last follow-up was 36 percent, and in BDI was 17 percent. No difference was shown in responder status at last follow-up between patients solely undergoing SAC versus additional procedures. Age, gender and types of obsessions or compulsions did not play a role in predicting response.

The researchers concluded that this study’s results, the largest series to date, demonstrate a 48-percent responder rate of SAC for treatment-refractory OCD with a >5-year follow-up. They contend that SAC is an effective, durable treatment alternative for patients suffering from severe OCD.

Disclosure: the author reports no conflicts of interest.

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Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,100 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.