Unilateral right anterior capsulotomy for refractory major depression with comorbid obsessive-compulsive disorder

Academic Article

Abstract

  • Background: Treatment-resistant major depression (MDD) and obsessive-compulsive disorder (OCD) remain a major cause of suffering and disability. These disorders may be treated with functional neurosurgery that almost always is bilateral but some patients might benefit from unilateral procedures. Methods: We performed a unilateral right anterior capsulotomy (AC) in a 45-year-old right-handed woman with MDD and comorbid OCD. This unilateral procedure was based on the results of neuropsychological testing and an 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) that revealed right hemisphere deficits in this patient. Results: Following surgery, Hamilton Depression scale (HAM-D) decreased 57% at 1 and 2 years and 54% at 3 years and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) decreased 58% at 1 year, 77% at 2 years, and 96% at 3 years. There was a slight decrement of verbal memory and phonemic fluency after the procedure that could also be related to changes in medication. Right basal ganglia abnormalities revealed by FDG-PET remained unchanged 16 months postoperatively. Conclusions: Overall this unilateral right AC was effective for the treatment of this woman's disorders with minimal adverse side effects. © 2011 Copyright 2011 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business.
  • Authors

    Published In

  • Neurocase  Journal
  • Digital Object Identifier (doi)

    Author List

  • Riestra AR; Aguilar J; Zambito G; Galindo y Villa G; Barrios F; García C; Heilman KM
  • Start Page

  • 491
  • End Page

  • 500
  • Volume

  • 17
  • Issue

  • 6