Thermocoagulation as a Surgical Approach for the Treatment of Obsessive-Compulsive Disorder in Refractory Patients: Systematic Review

Abstract

Obsessive-compulsive disorder (OCD), a disabling chronic neuropsychiatric disease, entails high economic costs to society and has high morbidity and mortality rates. The first-line treatments for OCD are selective serotonin reuptake inhibitors and cognitive-behavioral therapy. However, this disorder has the highest refractory index to noninvasive treatment. Alternatively, ablative thermocoagulation neurosurgical techniques have shown efficacy and few adverse effects. The present systematic review aimed to identify validated protocols to observe the effectiveness of ablative procedures in the treatment of severe and refractory OCD, as well as their possible adverse effects and benefits. This review supports the effectiveness of ablative methods by presenting them as a safe non-experimental therapeutic option for cases of highly-refractory OCD. Additional relevant findings were the improvement in cognitive function, functional capacity, affective orientation, and quality of life, which contribute to the destigmatization of this surgical technique. Further controlled studies may lead to the individualization of recommendations of targets for ablative thermocoagulation.

Resumo

O transtorno obsessivo-compulsivo (TOC), uma doença neuropsiquiátrica crônica e incapacitante, acarreta altos custos econômicos para a sociedade e tem taxas altas de morbidade e mortalidade. Os tratamentos de primeira linha para TOC são inibidores seletivos de recaptação da serotonina e terapia cognitivo-comportamental. No entanto, esse transtorno apresenta o índice refratário mais alto ao tratamento não invasivo. Alternativamente, as técnicas neurocirúrgicas de termocoagulação ablativa têm demonstrado eficácia e poucos efeitos adversos. Esta revisão sistemática teve como objetivo identificar protocolos validados para a observação da eficácia dos procedimentos ablativos no tratamento de TOC grave e refratário, bem como seus possíveis efeitos adversos e benefícios. Esta revisão apoia a eficácia dos métodos ablativos, apresentando-os como uma opção terapêutica não experimental e segura para casos de TOC altamente refratários. Outros achados relevantes foram a melhora de função cognitiva, da capacidade funcional, da orientação afetiva, e da qualidade de vida, que contribuem para a desestigmatização dessa técnica cirúrgica. Outros estudos controlados podem levar à individualização das recomendações de alvos para termocoagulação ablativa.

Keywords

obsessive compulsive disorder - refractory - thermocoagulation - neurosurgery

Palavras-chave

transtorno obsessivo-compulsivo - refratário - termocoagulação - neurocirurgia

Publikationsverlauf

Eingereicht: 22. Oktober 2020

Angenommen: 09. März 2021

Artikel online veröffentlicht:
30. August 2021

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