OCD Requiring Neurosurgery and Aftercare
Focused neurosurgery for the most refractory OCD, assessed carefully and followed closely
For a small number of people with OCD that has resisted every other treatment, a precisely targeted lesion in the circuit that drives the illness, an anterior capsulotomy or a cingulotomy, can bring lasting relief. These are among the oldest brain-based treatments for OCD: Queen Square has delivered them since the 1970s and remains the only centre in the UK that does. Modern techniques make the lesions small and exact, and in experienced hands they benefit as many as two-thirds of patients with otherwise intractable illness. They are irreversible, which is why the assessment before, and the care after, matter as much as the procedure itself. I work within the Unit of Functional Neurosurgery at Queen Square, alongside the neurosurgeons who perform them.
- Who is considered
- The criteria are at least as strict as for deep brain stimulation: severe, enduring OCD; adequate trials of medication, augmentation and intensive exposure-based therapy, all documented; a secure diagnosis; the capacity to consent to an irreversible procedure; and multidisciplinary agreement. Some people are considered for a lesion procedure after DBS has not helped enough, or because a device is unsuitable for them; others because a single procedure, with no hardware to maintain, better fits their circumstances.
- My role before surgery
- I assess the illness, the treatment history and the person; I confirm that the alternatives have been exhausted or arrange them if they have not; I assess mood, cognition and risk; and I present the case to the functional neurosurgery multidisciplinary meeting. I make sure you and your family understand what the procedure can and cannot do, and what the recovery involves, before any decision is made.
- Aftercare
- The weeks after surgery bring their own neuropsychiatric care: monitoring of mood, energy, motivation and cognition, which can change transiently; adjustment of medication; and, critically, exposure-based therapy to consolidate the gains as the obsessional drive recedes. Improvement after a lesion procedure often continues for many months. I follow patients with standardised measures, coordinate with the surgical team, and remain available for the long term.
- Working with colleagues
- I welcome referrals and requests for second opinions from psychiatrists and services around the country who have a patient with the most severe form of the illness and are unsure what remains to be tried. Often something does.
Neurosurgery for OCD is undertaken only after multidisciplinary review and with fully informed consent. I will discuss every option with you, including the option of not proceeding.
To arrange an assessment
Private Secretary
020 8123 0234 ·
secretary@drhimanshutyagi.com