People suffering from severe obsessive-compulsive disorder (OCD) that doesn’t respond to drug treatment may find relief with brain surgery, according to a Swedish study. However, there are considerable risks with the procedure, called capsulotomy.

As a “treatment of last resort,” capsulotomy involves creating lesions in the internal capsules of the brain to cut connections to the prefrontal cortex, which is hyperactive in OCD.

“Capsulotomy was reasonably effective,” Dr. Christian Ruck told Reuters Health, but “it had more frequent side effects than we anticipated.”

Of the 25 patients in the study, 12 had a successful response to capsulotomy in terms of a reduction or even remission of OCD symptoms, the researchers report in the Archives of General Psychiatry. However, 10 patients had clinically significant problems with decision making, excessive apathy, and uninhibited behavior.

Furthermore, there was an average weight gain in the first year after treatment of 6 kilograms, or about 13 pounds.

Capsulotomy can be performed using gamma radiation or radiofrequency energy to heat and destroy target areas. The type of capsulotomy had no bearing on the effectiveness of the treatment, the team found.

Just three of the patients in remission had no adverse effects. According to Ruck, with the Karolinska Institute in Stockholm, the take-home message is that “capsulotomy may be an effective treatment for some severely ill OCD patients but it carries a significant risk.”

MRI scans suggest that the safety of the operation could be improved by reducing the size of the lesions.

“The most important question now,” Ruck concluded, “is whether the risk of this procedure can be limited by small changes in surgical method. We hope to be able to study this with brain imaging using patients from several centers.”

SOURCE: Archives of General Psychiatry, August 2008.