May 27, 2003

Roberta Friedman, PhD

May 27, 2003 (Santa Cruz, California) — A study presented at the recent American Psychiatric Association annual meeting in San Francisco describes a series of patients with severe obsessive-compulsive disorder (OCD) who responded well to brain surgery. The patients had all failed both behavioral and pharmacologic treatment.

Steven Rasmussen, MD, associate professor of psychiatry at Brown University in Providence, Rhode Island, reported on 40 patients who had the surgery, carried out by gamma knife. Dr. Brown told Medscape that deep brain stimulation also shows promise for the disorder.

Putting it simplified terms, Dr. Rasmussen said, "We're cutting transmission with a lesion, or we are jamming the transmission, with stimulation."

Dr. Rasmussen, who is also medical director of Brown's Butler Hospital, reported on 15 patients who were given bilateral, single lesions delivered by gamma knife to the anterior limb of the internal capsule. Of these patients, 13 had a second bilateral lesion placed just below the initial one.

Five of the 15 patients responded to the procedure, as defined by a greater than 35% improvement on the Yale-Brown Obsessive Compulsive rating scale (YBOCS). At four years after surgery, 11 of 13 patients had a boost in the scores on the Global Assessment of Functioning from 32 to 52.

The two lesions were delivered in one surgical procedure for another 25 patients, 12 of whom showed improvement of their symptoms at six months, with at least a 25% lowering of scores on the YBOCS. Two thirds were much improved by this criterion at one year.

By a conservative measure of a 35% reduction in the YBOCS, 46% responded at one year after surgery.

For the use of deep brain stimulation for OCD, 16 implants to continuously stimulate the same region of the brain have been carried out so far worldwide. Dr. Rasmussen said it is too early to tell conclusively, but the stimulation approach appears to work well, though perhaps not as well as gamma knife surgery. He said the stimulator is approved for use in Parkinson's disease.

Marcio Bernik, MD, from the department of psychiatry at the USP Medical School in Sao Paulo, Brazil, who presented research on treatment-resistant patients with OCD, told Medscape in a comment on the report that the surgery to lesion the brain in OCD is used in his institute. "Eight to 12 people have gone through this operation, with some results," he said.

Because the alternative can be "10 years of inpatient psychiatric treatment," Dr. Bernik said that the surgery is worth trying.

Dr. Rasmussen consults for Medtronic.

APA 156th Annual Meeting: Symposium 65B. Presented May 21, 2003.

Reviewed by Gary D. Vogin, MD

Roberta Friedman, PhD, is a freelance writer for Medscape.

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