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Dr. Sheth’s Discovery: How to Predict Success of OCD Surgery

MRI_anterior_cingulate
MRI image side view of the brain. Anterior cingulate cortex in yellow. By Geoff B Hall (Own work) [CC0], via Wikimedia Commons

Patients, doctors, and media outlets are sitting up and taking notice of new research, published by Columbia Neurosurgeon Dr. Sameer Sheth, on the treatment of obsessive-compulsive disorder (OCD).

Dr. Sheth is senior author* of a paper, Neuroanatomical predictors of response to dorsal anterior cingulotomy for obsessive-compulsive disorder, out in the most recent issue of JAMA Psychiatry. Once published, the Journal immediately sent out a press release to announce the study’s remarkable findings.

What is the big deal?

OCD affects millions of people in the US, and it can be a debilitating disease. For about 10% of people with OCD, traditional treatment doesn’t help. For them, there is a surgical option, but it too is not 100% effective. Dr. Sheth has discovered concrete anatomical features seen by MRI that can now be used to predict a good surgical outcome.

One of the surgical options available to those with hard-to-treat OCD is called dorsal anterior cingulotomy. The procedure has been around for more than 50 years, but it has come a long way in that time. Now, surgeons like Dr. Sheth use sophisticated computers, image guidance technology, and microelectrode recording techniques with incredible precision to perform the operation.

The surgery is performed deep in a part of the brain that controls emotion and behavior, called the cingulate cortex–hence the name “cingulotomy.” During the procedure, surgeons create tiny lesions in this region (See the image above), and for reasons that are still under investigation, patients can have considerable relief of OCD symptoms as a result.

The surgery is safer now than it has ever been. But brain surgery has inherent risks and Dr. Sheth aims to do everything he can to minimize these. That is why he and his colleagues* conducted research to see if there is a way to better predict who will be helped by the surgery and who won’t.

To perform the study, Dr. Sheth and his team* reviewed brain scans that had been taken prior to OCD surgery on 15 patients. Eight of the patients had been helped by their surgery, and seven had not. The team found that the outcome of surgery was associated with several anatomical factors that can be identified on an MRI scan.

Simple anatomical differences, then, can help doctors predict which patients will respond best to surgery.

“The ability to predict with greater certainty who is more likely to benefit helps us counsel our patients on whether to consider neurosurgical treatment,” says Dr. Sheth. “Given the complexity of these patients’ symptoms and treatment history,” he adds, “evaluation for these procedures should be performed at specialized centers by a multi-disciplinary team with experience in psychiatric neurosurgery.”

To learn more about this research, read the JAMA Psychiatry press release. You can also read this press release picked up by DGNewsUS News & World ReportWebMDMedical XpressDoctors Lounge, and Monthly Prescribing Reference.

Dr. Sameer Sheth
Dr. Sameer Sheth

Read the full JAMA article for free here. JAMA also produced a five-minute recorded interview of Dr. Sheth, available on the right side of that web page.

Learn more about Dr. Sameer Sheth on his bio page here.

* The study’s co-authors include: Garrett P. Banks BS, Charles B. Mikell MD, Brett E. Youngerman MD, Bryan Henriques BS, Kathleen M. Kelly BS, Andrew K. Chan BS, Diana Herrera, Darin D. Dougherty MD, Emad N. Eskandar MD4, and Sameer A. Sheth MD PhD.

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