MR can be used to identify brain variations in patients with obsessive-compulsive disorder (OCD) who don't respond to medication or therapy, and would benefit from a neurosurgical procedure, according to a new Columbia University study published online by JAMA Psychiatry.

But in a related editorial, Dr. Odile A. van den Heuvel of the VU University Medical Center voiced concerns. "The consensus guideline on neurosurgery in psychiatry stresses the importance of being careful not to prematurely designate an investigational intervention as the standard of care," he wrote.

Researchers noted that 10 percent to 20 percent of OCD patients do not respond to traditional medications or therapy. This could make them candidates for dorsal anterior cingulotomy, which is a surgical procedure that damages the part of the brain that is thought to play a role in the neural network that causes OCD.
Researchers at Columbia University did MR scans on a total of 15 patients to evaluate the differences between those who might benefit from surgery. By analyzing patients' anterior cingulate cortex structure and connectivity, they found that eight would be likely to benefit from the operation.

Van den Heuvel advised caution in his editorial, suggesting that small pilot studies be conducted to optimize the targets for surgical interventions and the parameters of invasive and noninvasive neuromodulation. He also added that comparative studies that show short-term and long-term outcomes are vital.

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