Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder

Background: Obsessive-compulsive disease (OCD) is a severe psychiatric disorder suffers tens of millions of people around the world. There are many treatment options available, however, still nearly 40% of OCD patients do not respond very well to the therapeutic methods. For treatment-refractory OCD patients, bilateral anterior capsulotomy is a potential therapy. Methods: 53 (32 men and 21 women) medically intractable OCD patients who underwent MRI guided bilateral anterior capsulotomy from 2003 to 2006 were included in this study. Pre- and post-operative Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) scores were recorded by psychiatrists. FDG-PET was performed pre-operatively and 12 months after the operation to assess the effect of the operation. Results: There was a marked difference in FDG-PET findings before and 12 months after the operation. For OCD symptoms, 20 (37.9%) cases were regarded as OCD symptoms free, 13 (24.5%) cases as significant improved, 8 (15.0%) cases as clinical improved and 12 (22.6%) cases experienced no effects or improvements. There is also a significant difference in Y-BOCS, HAMD and HAMA scores (two-tailed t-test). Conclusions: Our study indicates that bilateral capsulotomy is a precise and relatively safe therapy for refractory OCD, which can improve patients' quality of life and restores their social function. There must be strict inclusion criteria for patients considering of the complications and the irreversibility of this procedure. (C) 2014 Elsevier B.V. All rights reserved.