Thermocoagulation Treatment of a Patient with Obsessive Compulsive Disorder and Substance Use Disorder: Case Report

Abstract

Obsessive compulsive disorder (OCD) is a possible cause associated with substance use disorder (SUD), a set of physical, psychological, behavioral, and cognitive phenomena related to the use of one or more chemical substances as a priority in a person's life that compromises quality of life. Since they can share the same neuronal network, this serves as a basis for neurosurgical procedures in cases refractory to conventional therapies. A 31-year-old male patient with a history of OCD and SUD refractory to conventional therapies underwent bilateral ablative stereotactic neurosurgery of the anterior limb of the internal capsule, the subgenual cingulate region, the nucleus accumbens, and the cingulate gyrus. Up to 33 months after the the procedure, the patient showed an absolute improvement in OCD and SUD and reported lack of withdrawal signs or symptoms and/or need to use drugs. In recent years, ablative neurosurgery has proven to be an alternative to OCD refractoriness, with long-term benefits. In the case analyzed, ablative stereotactic neurosurgery was effective in controlling both the signs and symptoms triggered by OCD, as well as those of anxiety and stress.

Resumo

O transtorno obsessivo-compulsivo (TOC) é uma possível causa associada ao transtorno por uso de substâncias (TUS), um conjunto de fenômenos físicos, psicológicos, comportamentais e cognitivos relacionados ao uso de uma ou mais substâncias químicas como prioridade na vida de uma pessoa que compromete sua qualidade de vida. Como estes transtornos podem compartilhar a mesma rede neuronal, isto serve de base para procedimentos neurocirúrgicos em casos refratários às terapias convencionais. Um paciente do sexo masculino de 31 anos com história de TOC e TUS refratários às terapias convencionais foi submetido a neurocirurgia estereotáxica ablativa bilateral do braço anterior da cápsula interna, da área subgenual, do núcleo accumbens e do giro do cíngulo. Até 33 meses após o procedimento, o paciente apresentou melhora absoluta do TOC e do TUS e relatou ausência de sinais ou sintomas de abstinência e/ou necessidade de uso de medicamentos. Nos últimos anos, a neurocirurgia ablativa tem se mostrado uma alternativa à refratariedade do TOC, com benefícios a longo prazo. No caso analisado, a neurocirurgia estereotáxica ablativa foi eficaz no controle tanto dos sinais e sintomas desencadeados pelo TOC como dos de ansiedade e estresse.

Keywords

stereotaxic technique - substance-related disorder - obsessive-compulsive disorder - neurosurgery - psychiatry - quality of life

Palavras-chave

técnica estereotáxica - transtorno relacionado ao uso de substâncias - transtorno obsessivo-compulsivo - neurocirurgia - psiquiatria - qualidade de vida

Publikationsverlauf

Eingereicht: 16. Juli 2021

Angenommen: 30. Juli 2021

Artikel online veröffentlicht:
24. Januar 2022

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