Brain surgery helps with severe OCD, but has risks

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Capsulotomy -- a neurosurgical operation that involves severing nerve fibers in the central part of the brain -- can be an effective treatment for the most severe forms of obsessive-compulsive disorder (OCD) and anxiety, but patients often experience a major personality change, including persistent apathy and sexual disinhibition.

The findings, which were discussed this week at the Euroscience Open Forum in Munich, Germany, are based on a study of 51 patients who were treated at the Karolinska Institute in Sweden. Roughly two patients a year have undergone capsulotomy for OCD/anxiety at the Institute since the procedure was developed there in the 1950s.

"The frequency of adverse effects was higher than expected," Dr. Christian Ruck of the Karolinska Institute said in a statement. "Neurosurgery for mental disorders is currently gaining a lot of attention in the professional community with new ongoing trials in several countries and I think our results are another reason for caution", stated Ruck.

After undergoing capsulotomy, patients in the current study were followed for up to 23 years with a variety of measures, including questionnaires, interviews, neuropsychological testing, and brain imaging.

While the operation often led to resolution of the most severe OCD symptoms, over a third of patients developed apathy and had problems planning and executing activities. Other serious side effects included epilepsy, sexual disinhibition, and urinary incontinence.

The frequency of side effects reported in the present study, the largest to date to examine the long-term effects of capsulotomy, differs from what has been reported at other centers, Ruck noted. "The other studies found very few risks with the surgery."

As to the reason for the different outcomes, Ruck said it may relate to the length of follow-up. "There are almost no studies with long-term follow-up. I think it has just been assumed that the procedure is safe, so people have stopped doing proper follow-up."

"Whether capsulotomy is a good treatment for severe OCD and anxiety depends on who you ask," Ruck told Reuters Health. Most doctors "consider the side effects experienced by the patients to be pretty severe." The patients themselves, however, seemed glad to trade their OCD symptoms for the apathy and other side effects experienced, he added.

In light of the current findings, Ruck said his initial "enthusiasm for capsulotomy as a treatment for severe OCD has faded."

The good news is that in recent years some effective psychological methods of treating severe OCD and anxiety have appeared, including intensive cognitive behavioral therapy, he added.