What is the role of neurosurgery in the treatment of obsessive-compulsive disorder (OCD)?

Updated: May 17, 2018
  • Author: William M Greenberg, MD; Chief Editor: David Bienenfeld, MD  more...
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Answer

Neurosurgical treatment of OCD is performed at a limited number of centers and is reserved for patients with severe and refractory symptoms. The most common small series use a specific small lesion (eg, cingulotomy) or deep brain stimulation. Current clinical trials are also exploring the application of transcranial magnetic stimulation (TMS), a noninvasive treatment, for OCD.

One surgical technique involves the stereotactic placement of bilateral lesions in the anterior cingulate cortex. A case series of 18 patients showed a 28% response rate, with an additional 17% showing a partial response. No significant adverse neurologic or cognitive sequelae were noted.

A deep brain stimulation technique consists of implanting a device to electrically stimulate the subthalamic nucleus. A crossover study in 17 patients with severe, refractory OCD in which patients received 3 months of active stimulation and 3 months of sham stimulation in randomized order, found that there was significantly more improvement during the active stimulation periods. However, serious adverse events were substantial and included intracerebral hemorrhage and infection. [12]

In February 2009, the FDA approved the use of Reclaim Deep Brain Stimulation Therapy for individuals with chronic, severe OCD. This device is an implanted medical device that is designed to target a region called the ventral capsule/ventral striatum, which is in the anterior limb of the internal capsule of the brain.

The Obsessive Compulsive Foundation can provide a list of centers with experience in neurosurgical OCD treatment.


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