Cingulotomy for intractable obsessive-compulsive disorder : prospective long-term follow-up of 18 patients

BACKGROUND The purpose of this study was to assess prospectively long-term change in obsessive-compulsive disorder (OCD) symptoms in patients with an OCD diagnosis that was confirmed by structured interview and with documented unsuccessful trials of multiple medications and attempts at behavior therapy. METHODS We conducted an unblinded preoperative and follow-up assessment of comorbid diagnosis; OCD, depressive, and anxiety symptoms; and functional status in 18 patients who underwent cingulotomy. RESULTS At a mean follow-up of 26.8 months, five patients (28%) met conservative criteria for treatment responders, and three others (17%) were partial responders. The group improved significantly in mean functional status, and few serious adverse events were found. Improvement in OCD symptoms was strongly correlated with improvement in depressive and anxiety symptoms. CONCLUSIONS The rate of clinical improvement was consistent with a previous retrospective study in the same setting, indicating that 25% to 30% of the patients who previously were unresponsive to medication and behavioral treatments are significantly improved after cingulotomy. Cingulotomy remains a last resort treatment for severely incapacitated patients who have not responded to all other state-of-the-art pharmacological and behavioral treatments for OCD and is not to be taken lightly.

[1]  C. McDougle,et al.  Obsessive–Compulsive Disorder with and without a Chronic Tic Disorder , 1994, British Journal of Psychiatry.

[2]  N. Alpert,et al.  Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography. , 1994, Archives of general psychiatry.

[3]  S. Rauch,et al.  Cingulotomy in a case of concomitant obsessive-compulsive disorder and Tourette's syndrome. , 1994, Archives of general psychiatry.

[4]  D. Cohen,et al.  Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome , 1993, Neurology.

[5]  S. Cumming,et al.  Treatment of obsessive‐compulsive disorder by psychosurgery , 1993, Acta psychiatrica Scandinavica.

[6]  M. Trimble,et al.  Obsessions in obsessive-compulsive disorder with and without Gilles de la Tourette's syndrome. , 1993, The American journal of psychiatry.

[7]  S. Rauch,et al.  Neurobiological models of obsessive-compulsive disorder. , 1993, Psychosomatics.

[8]  M. Jenike,et al.  Neurosurgical treatment of malignant obsessive compulsive disorder. , 1992, The Psychiatric clinics of North America.

[9]  P Pietrini,et al.  Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Revisualization during pharmacotherapy. , 1992, Archives of general psychiatry.

[10]  T. Insel,et al.  Toward a neuroanatomy of obsessive-compulsive disorder. , 1992, Archives of general psychiatry.

[11]  J. Mazziotta,et al.  Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. , 1992, Archives of general psychiatry.

[12]  S. Cumming,et al.  Psychosurgical Treatment of Obsessivecompulsive Disorder-Reply , 1992 .

[13]  M. Jenike,et al.  Cingulotomy for refractory obsessive-compulsive disorder. A long-term follow-up of 33 patients. , 1991, Archives of general psychiatry.

[14]  M. Jenike,et al.  Clomipramine in the treatment of patients with obsessive-compulsive disorder. The Clomipramine Collaborative Study Group. , 1991, Archives of general psychiatry.

[15]  W. Goodman,et al.  The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. , 1989, Archives of general psychiatry.

[16]  G C Curtis,et al.  Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive-compulsive disorder. , 1989, The Journal of neuropsychiatry and clinical neurosciences.

[17]  W. Wilson,et al.  Reliability and validity of SAFTEE: preliminar analyses. , 1986, Psychopharmacology bulletin.

[18]  M. Zimmerman,et al.  A structured interview for the DSM-III personality disorders. A preliminary report. , 1985, Archives of general psychiatry.

[19]  M. Bergner,et al.  The Sickness Impact Profile: Development and Final Revision of a Health Status Measure , 1981, Medical care.

[20]  G. Heilbrunn.  Anxiety and Emotions: Physiological Basis and Treatment , 1981 .

[21]  Robert J. Levine,et al.  Ethics and Regulation Of Clinical Research , 1982 .

[22]  Earp Jd.  Psychosurgery: The position of the Canadian Psychiatric Association. , 1979 .

[23]  P. Bridges,et al.  A Further Review of the Results of Stereotactic Subcaudate Tractotomy , 1975, British Journal of Psychiatry.

[24]  H. Eysenck,et al.  Manual of the Eysenck personality questionnaire , 1975 .

[25]  I. Marks,et al.  Bimedial Leucotomy in Obsessive-Compulsive Neurosis: A Controlled Serial Enquiry , 1971, British Journal of Psychiatry.

[26]  A. Beck,et al.  An inventory for measuring depression. , 1961, Archives of general psychiatry.

[27]  J. W. Papez.  A PROPOSED MECHANISM OF EMOTION , 1937 .