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Radiosurgery Gifts Hope for Severe Obsessive-Compulsive Disorder (OCD)
Patients with OCD get persistent, upsetting thoughts (obsessions) and use rituals (compulsions). Though these rituals are performed to control the anxiety these thoughts produce, they often end up controlling the patient. Compulsions include hand-washing, counting, checking, or cleaning. For example a patient may develop a compulsion to wash his/her hands over and over again. Severe OCD can keep a person from working or carrying out normal responsibilities at home.
Large epidemiological studies found that OCD was the fourth most common psychiatric disorder with a lifetime prevalence of 2.5%. It is highly prevalent and more prevalent than the schizophrenia and bipolar disorder.
Routine treatment modalities for OCD include management with certain medications and/or exposure-based psychotherapy. There are however refractory cases where a patient continues to suffer severe OCD despite taking multiple medications.
Alternatives in such cases included:
• Surgical procedure (anterior cingulotomy) - this involves manipulation of the ‘cingulate’ part of the brain
• Deep brain stimulation (DBS): Abnormal brain activity is disrupted using electrical stimulation
The search for a more efficient technique has been on for a while. A new experimental procedure called radiosurgery gifts hope for severe OCD. In this process a piece of equipment called a “gamma knife” is used to deliver an intense beam of radiation. This radiation is targeted to the anterior cingulate cortex, the area responsible for the OCD symptoms. Radiosurgery was originally developed as an alternative to surgery in the treatment of brain tumours.
Three patients (two women and one man) with extremely severe OCD who failed to respond to medications underwent radiosurgery. The procedure was completed without any complications and they were followed up to 4.5years. Significant functional improvements and reduction in OCD behaviour were noted. They had to continue their medications though.
Radiosurgery is not devoid of disadvantages:
• It is irreversible
• Brain stimulation patterns can’t be adjusted as in DBS
The advantage, however is that unlike DBS, radiosurgery avoids equipment-related complications. It doesn’t require implanted electrodes and generator.
Further research is solicited before radiosurgery may be prescribed on a wider scale.
Reference: Neurosurgery, January 2011- Volume 68
Source-Medindia
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