Is Cingulate Gyrus Ablation a Viable Treatment for Severe OCD?

I would like to ask if cingulate gyrus ablation for treating severe obsessive-compulsive disorder is currently very complicated?

Hello Doctor: I am a severe patient suffering from obsessive-compulsive disorder (OCD) and anxiety disorder, and I have been on psychiatric medication for long-term management.
Since becoming ill, my life has been extremely painful, and I feel like a shell of a person due to this condition.
I have been dealing with this illness for 8 years; medication can only control my symptoms but cannot cure them.
I have also seen many fellow patients in Taiwan who are deeply troubled by similar psychiatric disorders, taking large amounts of medication daily without any improvement in their conditions, and some even exhibiting self-harm behaviors.

Recently, I came across an article online that mentioned: "Cingulate gyrus ablation for OCD shows significant improvement in patients post-surgery with no initial side effects." A severe OCD patient underwent cingulate gyrus ablation at Tri-Service General Hospital, and two weeks post-operation, the patient showed significant improvement in OCD symptoms.
The neurosurgeons at the hospital noted that the initial observation of the surgery was quite successful, with no lasting side effects.
This female patient, 24 years old, had experienced OCD and anxiety symptoms for many years.
She had previously sought group therapy, psychological counseling, and medication treatment at Tri-Service General Hospital, Cathay General Hospital, and municipal rehabilitation centers, but with little effect.
During her time studying abroad, she even exhibited suicidal behavior.
Ultimately, upon the recommendation of the community psychiatry director, Dr.
Tang Huasheng, she sought surgical treatment at the neurosurgery department of Tri-Service General Hospital.

This stereotactic surgery involved creating symmetrical 0.8 cm diameter lesions in the anterior cingulate cortex of the brain, leaving only two 3 cm wounds on the top of her head post-operation.
The patient returned for suture removal on July 23 and was in good condition, and the noticeable changes before and after surgery brought relief to both her parents and doctors.
I would like to ask if cingulate gyrus ablation, which was originally used to alleviate cancer patients' pain and anxiety, is considered safe and effective for treating severe OCD and anxiety disorders.
Given its high safety and success rates, could this procedure be made available for severe OCD and anxiety disorder patients in our country?

Xiao Bai, 30~39 year old female. Ask Date: 2016/07/23

Dr. Zhang Junwei reply Neurosurgery

I apologize, but this is not my area of specialization, and I am unable to answer your question.

Reply Date: 2016/07/23

More Info

Cingulate gyrus ablation, also known as cingulotomy, is a neurosurgical procedure that has been explored as a treatment option for severe obsessive-compulsive disorder (OCD) and other treatment-resistant psychiatric conditions. This procedure involves the targeted destruction of a small area of the cingulate gyrus, which is part of the brain's limbic system and is involved in emotional regulation and cognitive control.
In cases of severe OCD, where patients have not responded adequately to conventional treatments such as psychotherapy and pharmacotherapy, cingulotomy may be considered as a last resort. The rationale behind this approach is that by disrupting the abnormal neural circuits associated with OCD, patients may experience a reduction in their obsessive thoughts and compulsive behaviors.

Research has shown that cingulotomy can lead to significant improvements in OCD symptoms for some patients. Studies indicate that approximately 30-50% of patients may experience a substantial reduction in symptoms following the procedure. However, it is important to note that the effectiveness can vary widely among individuals, and not all patients will benefit from this intervention.

Regarding safety, cingulotomy is generally considered to have a favorable safety profile, especially when compared to more invasive neurosurgical procedures. The risks associated with cingulotomy include potential cognitive changes, emotional blunting, and other neurological deficits, but these are relatively rare. The procedure is typically performed using stereotactic techniques, which allow for precise targeting of the brain tissue, thereby minimizing damage to surrounding areas.

As for the current status of cingulate gyrus ablation for OCD in Taiwan or elsewhere, it is essential to consult with a qualified psychiatrist or neurosurgeon who specializes in treating OCD. They can provide insights into the availability of this treatment option and whether it is appropriate for your specific case. In many regions, cingulotomy is still considered an experimental treatment and may not be widely available or accepted as a standard practice for OCD.

It is also crucial to consider that while cingulotomy may offer relief for some patients, it is not a guaranteed cure for OCD. The underlying neurobiological mechanisms of OCD are complex, and treatment outcomes can be influenced by various factors, including the patient's overall mental health, the presence of comorbid conditions, and the specific characteristics of their OCD.

In conclusion, cingulate gyrus ablation may be a viable treatment option for severe OCD in cases where traditional therapies have failed. However, it should be approached with caution, and thorough discussions with healthcare professionals are necessary to weigh the potential benefits against the risks. If you or someone you know is considering this treatment, it is advisable to seek a comprehensive evaluation and explore all available options, including ongoing research and clinical trials that may provide additional insights into the efficacy and safety of this procedure for OCD.

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