Table 2:

Summary of Recommendations for Neurosurgeries for Treatment-Refractory OCD

Entity (jurisdiction)	Recommendation	Source(s)
American Psychiatric Association (US)	Ablative neurosurgery for severe, treatment-refractory OCD is rarely indicated and, along with DBS, should be performed only at sites with expertise in both OCD and these treatment approaches	American Psychiatric Association, 200752,53
Canadian clinical practice guidelines (Canada)	Ablative neurosurgery Capsulotomy or cingulotomy may be effective in reducing symptoms in patients with severe, treatment-refractory OCD; however, these treatments are usually considered last resorts	Katzman et al, 20142
	DBS DBS may improve symptoms and functionality in up to two-thirds of patients with highly treatment-refractory OCD	Katzman et al, 20142
Congress of Neurological Surgeons and the American Society for Stereotactic and Functional Neurosurgery (US)	DBS Bilateral subthalamic nucleus DBS is recommended for medically refractory OCD, above best medical management; bilateral nucleus accumbens or BNST DBS may also be used	Staudt et al, 202154
Indian Psychiatric Society (India)	Ablative neurosurgery/DBS Can be recommended for carefully selected patients with treatment-refractory OCD after discussing the pros and cons	Janardhan Reddy et al, 201731
NICE (UK)	Ablative neurosurgery Not recommended for severe, chronic, treatment-resistant OCD unless a patient requests it; many considerations and due processes	NICE, 20 0521,a
	DBS DBS for chronic, severe, treatment-resistant OCD in adults should be done only in the context of research	NICE, 202155
Royal College of Psychiatrists Position Statement (UK)	Ablative neurosurgery Anterior capsulotomy and anterior cingulotomy are considered part of acceptable, safe, effective, and established clinical practice in the UK for chronic, otherwise treatment-refractory OCD	Royal College of Psychiatrists, 201728
	DBS Should be considered investigational and be used only within a research protocol that has full ethics approval	Royal College of Psychiatrists, 201728
World Federation of Societies of Biological Psychiatry (International)	Ablative neurosurgery RFA, Gamma Knife, and MRgFUS should be restricted to carefully selected patients with treatment-refractory OCD	Bandelow et al, 202318
	DBS DBS should be restricted to carefully selected patients with treatment-refractory OCD	Bandelow et al, 202318

Abbreviations: BNST, bed nucleus of the stria terminalis; DBS, deep brain stimulation; MRgFUS, magnetic resonance-guided focused ultrasound; NICE, National Institute for Health and Care Excellence; OCD, obsessive–compulsive disorder; RFA, radiofrequency ablation.

^aEvidence update completed in 2013; no new evidence was identified relevant to intensive or inpatient treatments for OCD.²⁰