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Brain Surgery Might Ease Tough-to-Treat OCD
Date:4/17/2012

d-washing or showering obsession, a person could take up to six hours a day, doing their washing ritual. That's just torture," Timpano added.

Frontline psychological treatment for obsessive-compulsive disorder is called exposure therapy. Medications include selective serotonin reuptake inhibitors (SSRIs). Estimates vary, but for a quarter or more of patients, these therapies don't work.

Neurosurgical options include gamma-knife surgery and deep brain stimulation, as well as cingulotomy. But potential candidates for these options must undergo a rigorous screening, Sheth said.

Both experts emphasized that the surgical candidates in the study had failed rounds of single- and multiple-drug therapies as well as behavioral therapies and were vetted by a multidisciplinary committee.

Most patients who do undergo a cingulotomy don't experience any complications, Sheth said. In his study, he reported, three developed abulia -- a difficulty in interacting and unresponsiveness -- lasting a few days; one patient developed seizures that required medication, and another had an infection.

In addition, he said, two patients committed suicide at some point after undergoing the procedure. One occurred a few weeks after the surgery, and the other about a year later. He noted that along with obsessive-compulsiveness, patients are monitored for depression.

"These patients with this severe OCD often have [co-existing] depression, major depression," he said. "So in a group of moderately to severely depressed patients over a 20-year time span, two out of the 63 is probably a similar fraction to what you'd expect."

The research is ongoing, Sheth added, with the team keeping track of these patients -- who come from all over the world -- indefinitely.

And Timpano noted, "I think it's important that they've demonstrated this follow-up on a fairly large group of patients. It really lets us see how people who've received the cingulotomy do in the
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