Tags

Type your tag names separated by a space and hit enter

Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature.
J Neurosurg. 2015 May; 122(5):1028-37.JN

Abstract

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.

Authors+Show Affiliations

Unit of Functional Neurosurgery, University College London Institute of Neurology, Queen Square;No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

25635480

Citation

Pepper, Joshua, et al. "Deep Brain Stimulation Versus Anterior Capsulotomy for Obsessive-compulsive Disorder: a Review of the Literature." Journal of Neurosurgery, vol. 122, no. 5, 2015, pp. 1028-37.
Pepper J, Hariz M, Zrinzo L. Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature. J Neurosurg. 2015;122(5):1028-37.
Pepper, J., Hariz, M., & Zrinzo, L. (2015). Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature. Journal of Neurosurgery, 122(5), 1028-37. https://doi.org/10.3171/2014.11.JNS132618
Pepper J, Hariz M, Zrinzo L. Deep Brain Stimulation Versus Anterior Capsulotomy for Obsessive-compulsive Disorder: a Review of the Literature. J Neurosurg. 2015;122(5):1028-37. PubMed PMID: 25635480.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Deep brain stimulation versus anterior capsulotomy for obsessive-compulsive disorder: a review of the literature. AU - Pepper,Joshua, AU - Hariz,Marwan, AU - Zrinzo,Ludvic, Y1 - 2015/01/30/ PY - 2015/1/31/entrez PY - 2015/1/31/pubmed PY - 2015/7/15/medline KW - AC = anterior capsulotomy KW - CBT = cognitive behavioral therapy KW - DBS = deep brain stimulation KW - ICH = intracranial hemorrhage KW - NAcc = nucleus accumbens KW - OCD = obsessive-compulsive disorder KW - VC/VS = ventral capsule/ventral striatum KW - YBOCS = Yale-Brown Obsessive-Compulsive Scale KW - anterior capsulotomy KW - deep brain stimulation KW - functional neurosurgery KW - obsessive-compulsive disorder KW - psychosurgery SP - 1028 EP - 37 JF - Journal of neurosurgery JO - J. Neurosurg. VL - 122 IS - 5 N2 - 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. SN - 1933-0693 UR - https://www.unboundmedicine.com/medline/citation/25635480/Deep_brain_stimulation_versus_anterior_capsulotomy_for_obsessive_compulsive_disorder:_a_review_of_the_literature_ L2 - https://thejns.org/doi/10.3171/2014.11.JNS132618 DB - PRIME DP - Unbound Medicine ER -