Characteristics of Patients Undergoing Neurosurgery for Treatment-refractory OCD and MDD
Though selection criteria have not been standardized across cent-ers, a review of most reported studies from several countries sug-gests that only a small number of OCD or MDD patients who have not responded to a variety of exhaustive treatments are considered for palliative neurosurgery. Treatments include multiple adequate medication trials, an adequate trial of behavioral treatment/psycho-therapy and electroconvulsive therapy (ECT) for MDD – encom-passing patients who remain severely disabled for several years de-spite these efforts (Table 75.1). In addition to the essential informed consent of the patient, a panel of specialists, usually constituted at the institutional level, carefully reviews all aspects of the patient’s condition before making a consensus decision on surgery.
Severe, chronic OCD and MDD referrals commonly present with comorbidities including depression, obsessive–compulsive “psychosis”, substance abuse, history of harmful behavior and personality disorders. The decision to offer surgery must be eval-uated on a case-by-case basis, carefully considering the benefits and risks of intervention, alongside those of nonintervention. Tables 75.2 and 75.3 contain guidelines for indications and rela-tive contraindications for these procedures evolved in the con-text of 25 years of experience with the stereotactic cingulotomy procedure for intractable psychiatric disorder at one center. (Massachusetts General Hospital (MGH): OCD Clinic and Cingulotomy Program, Boston, MA, USA).