Table 1:

Summary of Considerations for Determining Eligibility and Suitability for Neurosurgical Intervention for Patients With OCD

Entity	Eligibility guidance	Additional considerations
Committee for Neurosurgery for Psychiatric Disorders, part of the World Society for Stereotactic and Functional Neurosurgery (WSSFN) and the European Society for Stereotactic and Functional Neurosurgery (ESSFN)a Consensus Guidelines24	Severe, chronic, disabling disorder Documented failure11 or limited response to trials of adequate dose and duration of available standard therapies1 No reasonable, less-invasive, evidence-based therapy available Little hope for spontaneous recovery Promise of meaningful improvement	Ability or capacity to give informed consent Suicide risk Cognitive abilities, psychiatric status, personality and interpersonal functioning, goals and expectations of surgery, treatment adherence, and level of family or other psychosocial support
Indian Psychiatric Society,31 Indian Society for Stereotactic and Functional Neurosurgery, and The Neuromodulation Society Consensus Criteria 201929	Severe (Y-BOCS score ≥28 or ≥14 in case of illness with predominant obsessions or compulsions) and chronic OCD Substantial distress and impairment in functioning (GAF ≤ 45) due to OCD Lack of response to adequate and multiple trials of treatment options’1	Patient provides informed consent Willingness to undergo preoperative evaluation and periodic postoperative follow-up Presence of relative contraindications (e.g., comorbid intellectual disability, psychosis, unstable neurological conditions)
Royal College of Psychiatrists Position Statement 2017 (UK)28	Treatment-refractory meeting consensus criteria for severity and refractoriness Carefully selected with difficulty with OCD symptoms Consider patient preference Risks of neurosurgery versus risk of continuing “standard care”	Special attention to patient advocacy, assess capacity, and gain informed consent Explain to patients that neurosurgery is only 1 component of a broader, comprehensive treatment plan Comprehensive postoperative follow-up and treatment plan (12 mo minimum)

Abbreviations: GAF, Global Assessment of Functioning; OCD, obsessive–compulsive disorder; Y-BOCS, Yale-Brown Obsessive–Compulsive Scale.

^aPartnering with the working group “Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application”, the Psychiatric Neurosurgery Committee of the American Society for Stereotactic and Functional Neurosurgery (ASSFN), the Latin American Society for Stereotactic and Functional Neurosurgery (SLANFE), the Asian-Australasian Society for Stereotactic and Functional Neurosurgery (AASSFN), and the World Psychiatric Association (WPA).

^bLack of efficacy or disabling side effects.

^cFor example, pharmacotherapy and behavioural therapy. As outlined by Visser-Vanderwalle et al³⁰: “insufficient response to, at minimum: 2 selective serotonin reuptake inhibitors (SSRIs) at the maximum tolerated dose for at least 12 weeks; clomipramine at a maximum tolerated dosage for at least 12 weeks; 1 augmentation trial with an antipsychotic for at least 8 weeks, in combination with one of the aforementioned drugs; and a complete trial of exposure-based cognitive behavioural therapy (CBT) confirmed by a psychotherapist.”

^dIncludes systematic treatment trials not discontinued prematurely due to mild side effects as follows: at least 3 months of ≥2 SSRIs and clomipramine, plus augmentation with at least 1 antipsychotic for at least 8 weeks and adequate trial of exposure and response prevention (ERP) CBT (≥20 sessions) or inability to tolerate the anxiety caused by therapy.²⁹

Sources: Visser-Vanderwalle et al,³⁰ Nuttin et al,²⁴ Royal College of Physicians,²⁸ Doshi et al.²⁹