Gamma Knife Surgery (GKS) for the Treatment of Obsessive-Compulsive Disorder (OCD) Refractory to Pharmacological Therapy: State of the Art and Review of the Literature

Abstract

Obsessive-compulsive disorder (OCD) is a psychiatric condition characterised by ritualised behaviours and anxiety-stimulating thoughts. In severe cases, refractory to medical treatments, symptoms can have a substantial impact on patient’s social life, with important direct and indirect costs. Radiosurgery (gamma knife surgery (GKS)) and functional neurosurgery (deep brain stimulation (DBS)) have been employed as therapeutic approaches for the more severe cases of the disorder. This systematic review aims to evaluate use of GK for OCD refractory patients. The main biomedical databases (PUBMED, EMBASE, SCOPUS and Cochrane) were investigated for English-written studies regarding the use of surgical treatments in case of medically refractory OCD. Special attention was given to the patient number, approach, outcomes and complications. A high response after the procedures was seen by the use of gamma knife (GK) treatment (48.26%). It has been noted that gamma knife radiosurgery (GKRS) anterior capsulotomy shows positive and effective responses to treating refractory OCD. Furthermore, there is low evidence of GKRS capsulotomy to be effective to decreasing depression and anxiety symptoms and improving the quality of life. The main complications after the radiosurgical treatment were mood disturbances, lethargy, insomnia, cerebral oedema, gastrointestinal symptoms, radiation necrosis, weight/appetite changes and brain cysts. Although the pharmacological advancements favoured the treatment of OCD patients, the general management is still complex and presents several difficulties. In a selected group of patients refractory to pharmacological treatments and cognitive behavioural therapy, radiosurgical intervention (GKS) is seen to be a valid solution. The review of the literature presented shows that GKRS is a valid alternative in the treatment of refractory OCD.