Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder

Clinical article

Andre F. Gentil, Antonio C. Lopes, Darin D. Dougherty, Christian Rück, David Mataix-Cols, Teagan L. Lukacs, Miguel M. Canteras, Emad N. Eskandar, Johan Larsson, Marcelo Q. Hoexter, Marcelo C. Batistuzzo, Benjamin D. Greenberg, Euripedes C. Miguel

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Object. Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods. Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results. Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%-41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions. The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

Original languageEnglish (US)
Pages (from-to)123-130
Number of pages8
JournalJournal of Neurosurgery
Volume121
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Limbic System
Obsessive-Compulsive Disorder
Therapeutics
Hoarding
Checklist
Analysis of Variance

Keywords

  • Anterior cingulotomy
  • Capsulotomy
  • Functional neurosurgery
  • Hoarding
  • Obsessive-compulsive disorder
  • Radiosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder : Clinical article. / Gentil, Andre F.; Lopes, Antonio C.; Dougherty, Darin D.; Rück, Christian; Mataix-Cols, David; Lukacs, Teagan L.; Canteras, Miguel M.; Eskandar, Emad N.; Larsson, Johan; Hoexter, Marcelo Q.; Batistuzzo, Marcelo C.; Greenberg, Benjamin D.; Miguel, Euripedes C.

In: Journal of Neurosurgery, Vol. 121, No. 1, 01.01.2014, p. 123-130.

Research output: Contribution to journalArticle

Gentil, AF, Lopes, AC, Dougherty, DD, Rück, C, Mataix-Cols, D, Lukacs, TL, Canteras, MM, Eskandar, EN, Larsson, J, Hoexter, MQ, Batistuzzo, MC, Greenberg, BD & Miguel, EC 2014, 'Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder: Clinical article', Journal of Neurosurgery, vol. 121, no. 1, pp. 123-130. https://doi.org/10.3171/2014.2.JNS131423
Gentil, Andre F. ; Lopes, Antonio C. ; Dougherty, Darin D. ; Rück, Christian ; Mataix-Cols, David ; Lukacs, Teagan L. ; Canteras, Miguel M. ; Eskandar, Emad N. ; Larsson, Johan ; Hoexter, Marcelo Q. ; Batistuzzo, Marcelo C. ; Greenberg, Benjamin D. ; Miguel, Euripedes C. / Hoarding symptoms and prediction of poor response to limbic system surgery for treatment-refractory obsessive-compulsive disorder : Clinical article. In: Journal of Neurosurgery. 2014 ; Vol. 121, No. 1. pp. 123-130.
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abstract = "Object. Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods. Data from 77 patients from 3 different research centers at S{\~a}o Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; S{\~a}o Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results. Mean Y-BOCS scores decreased 34.2{\%} after surgery (95{\%} CI 27.2{\%}-41.3{\%}), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7{\%} ± 25.9{\%} vs 41.6{\%} ± 32.2{\%}, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions. The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.",
keywords = "Anterior cingulotomy, Capsulotomy, Functional neurosurgery, Hoarding, Obsessive-compulsive disorder, Radiosurgery",
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T2 - Clinical article

AU - Gentil, Andre F.

AU - Lopes, Antonio C.

AU - Dougherty, Darin D.

AU - Rück, Christian

AU - Mataix-Cols, David

AU - Lukacs, Teagan L.

AU - Canteras, Miguel M.

AU - Eskandar, Emad N.

AU - Larsson, Johan

AU - Hoexter, Marcelo Q.

AU - Batistuzzo, Marcelo C.

AU - Greenberg, Benjamin D.

AU - Miguel, Euripedes C.

PY - 2014/1/1

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N2 - Object. Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods. Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results. Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%-41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions. The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

AB - Object. Recent findings have suggested a correlation between obsessive-compulsive disorder (OCD) symptom dimensions and clinical outcome after limbic system surgery for treatment-refractory patients. Based on previous evidence that the hoarding dimension is associated with worse outcome in conventional treatments, and may have a neural substrate distinct from OCD, the authors examined a large sample of patients undergoing limbic surgery (40 with capsulotomy, 37 with cingulotomy) and investigated if symptom dimensions, in particular hoarding, could influence treatment outcome. Methods. Data from 77 patients from 3 different research centers at São Paulo (n = 17), Boston (n = 37), and Stockholm (n = 23) were analyzed. Dimensional Yale-Brown Obsessive Compulsive Scale (Y-BOCS; São Paulo) or Y-BOCS Symptom Checklist scores (Boston and Stockholm) were used to code the presence of 4 well-established symptom dimensions: forbidden thoughts, contamination/cleaning, symmetry/order, and hoarding. Reductions in YBOCS scores determined clinical outcome. Results. Mean Y-BOCS scores decreased 34.2% after surgery (95% CI 27.2%-41.3%), with a mean follow-up of 68.1 months. Patients with hoarding symptoms had a worse response to treatment (mean Y-BOCS decrease of 22.7% ± 25.9% vs 41.6% ± 32.2%, respectively; p = 0.006), with no significant effect of surgical modality (capsulotomy vs cingulotomy). Patients with forbidden thoughts apparently also had a worse response to treatment, but this effect was dependent upon the co-occurrence of the hoarding dimension. Only the negative influence of the hoarding dimension remained when an ANOVA model was performed, which also controlled for preoperative symptom severity. Conclusions. The presence of hoarding symptoms prior to surgery was associated with worse clinical outcome after the interventions. Patients with OCD under consideration for ablative surgery should be carefully screened for hoarding symptoms or comorbid hoarding disorder. For these patients, the potentially reduced benefits of surgery need to be carefully considered against potential risks.

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KW - Hoarding

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KW - Radiosurgery

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