Surgical Approaches in Refractory Obsessive Compulsive Disorder: From Leukotomy to Gamma Knife Surgery

Year 2015, Volume: 24 Issue: 2, 239 - 250, 05.03.2015

Ebru Altıntaş

https://doi.org/10.17827/aktd.29712

Abstract

Obsessive Compulsive Disorder (OCD) is a chronic and debilitating disorder that can cause significant distress and interference with daily functioning and impairment in quality of life, social and familial relationship. Selective serotonin reuptake inhibitors and cognitive-behavioral therapy are currently viewed as the first line treatments of choice for OCD. Approximately 30-40% OCD patients fail to respond to these treatments. Anterior capsulotomy, cingulotomy, limbic leucotomy, subcaudate tractotomy are used for the treatment of refractory OCD. The studies suggested that gamma knife capsulotomy caused improvements in 55-70% refractory OCD patients. Many studies suggest that psychosurgery is a beneficial, well tolerated and safe method. This study aimed to report efficacy, adverse effects and long term effects of surgery techniques especially gamma knife and deep brain stimulation in refractory OCD patients .

Keywords

Obsessive-compulsive disorder, capsulotomy, gamma knife, deep brain stimulation

Tedaviye Dirençli Obsesif Kompulsif Bozuklukta Cerrahi Yaklaşımlar : Lökotomiden Gama Bıçağı Cerrahisine

Abstract

Obsesif Kompulsif Bozukluk(OKB) obsesyon ve kompulsiyonlarla karakterize yaygın bir ruhsal bozukluktur. Obsesif Kompulsif Bozukluk, sosyal, ailesel ilişkiler, yaşam kalitesi ve günlük işlevlerde bozulma yapan, önemli derecede strese yol açan kronik ve zayıf düşürücü bir hastalıktır. Selektif seratonin geri alım inhibitörleri ve bilişsel davranışçı terapi, OKB’nin tedavisinde ilk tercih yöntemleridir. Yaklaşık olarak %30-40 OKB hastası bu tedaviye yanıt vermez. Anterior kapsülotomi, singulotomi, subkaudat traktotomi, limbik lökotomi dirençli OKB’nin cerrahi tedavisinde kullanılabilir. Araştırmalar, gama kapsulotominin %55-70 dirençli OKB hastasında düzelme sağladığını göstermiştir. Literatürde, psikiyatrik cerrahinin faydalı, iyi tolere edilen ve güvenilir bir yöntem olduğu bazı araştırmalarda sunulmuştur. Bu derlemenin amacı, tedaviye dirençli OKB hastalarında kullanılan cerrahi yöntemlerin özellikle gama bıçağı kapsülotomi ve derin beyin stimülasyonunun etkinliği, yan etkileri ve uzun dönem etkilerini sunmaktır.

Keywords

Obsesif-kompulsif bozukluk, kapsülotomi, gama bıçağı, derin beyin stimülasyonu

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