A minority of patients with obsessive-compulsive disorder (OCD) have a
chronic course and extreme disability, with symptoms refractory to
pharmacological and psychological treatment. Considerable uncontrolled
evidence suggests such cases may respond to neurosurgical intervention. The
authors update current stereotactic procedures and their efficacy, safety,
and side effect profiles. The design of an ongoing placebo- controlled
trial of Gamma Knife capsulotomy for refractory OCD is outlined. Drug
treatment of OCD may be assumed to affect a proposed functional imbalance
between the frontal lobes and other parts of the brain. As for
neurosurgical treatments, both the effects and side effects may be viewed
as expressions of their influence on this functional imbalance.Abstract Teaser