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Functional Neurosurgery in Severe and Treatment-Refractory OCD 

Functional Neurosurgery in Severe and Treatment-Refractory OCD
Functional Neurosurgery in Severe and Treatment-Refractory OCD

Erica C. Keen

, Alik S. Widge

, and Darin D. Dougherty

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date: 26 June 2022

Although most patients with obsessive-compulsive disorder (OCD) attain adequate symptomatic relief with conventional first-line treatments, a meaningful fraction remain incapacitated despite numerous medication trials and intensive behavioral therapy (Garnaat et al., 2014). A subset of these patients may be candidates for surgical treatment. Stereotactic neurosurgical lesions have been used successfully since the 1960s to treat patients with especially severe, chronic, treatment-refractory OCD. This chapter briefly reviews the history of psychiatric neurosurgery and the development of the four current neurosurgical approaches to OCD. It discusses issues related to the careful selection of appropriate surgical candidates. It then reviews available outcomes data for each of the four surgical procedures. The putative mechanisms of action of these ablative neurosurgeries, in the context of our current understanding of the pathophysiology of OCD, are explored. The chapter concludes with future directions in which psychiatric neurosurgery may evolve to address current limitations and harness more fully its therapeutic potential for patients with OCD.

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