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1 Neurosurgery for severe OCD: the past, present and future
  1. Eileen Joyce
  1. Professor of Neuropsychiatry at The Institute of Neurology, University College London. Her current research focuses on interventions for neuropsychiatric disorders such as schizophrenia, OCD and Tourettes syndrome and their mechanisms of action. Professor Joyce obtained her first degree in experimental psychology and PD in dopamine psychopharmacology from the University of Cambridge. She then went into medicine also at Cambridge. She trained in psychiatry at the Bethlem and Maudsley Hospitals and spent several years as a research worker at the Institute of Psychiatry, where she was a Wellcome Trust Lecturer in Mental Health followed by time at the USA National Institutes of Health. Before moving to UCL/UCLH, she was Professor of Neuropsychiatry at Imperial College London. Prof Joyce is also the PI for UCL-MRC trial of DBS for treatment refractory OCD


Obsessive compulsive disorder (OCD) is a common disorder thought to have a prevalence of 1-2%. The majority of patients are helped by treatments such as exposure and response prevention therapy and medication. A significant minority fail to benefit from optimal treatment and are severely disabled with respect to everyday function.

Such patients may be candidates for a neurosurgical approach. This talk will trace the development of neurosurgery for severe OCD beginning with leucotomy/lobotomy which was practiced in the early part of the 20th Century and left an unfavourable legacy. Advancements in neurosurgery have allowed techniques such as anterior cingulotomy and anterior capsulotomy to be practiced at present and will be compared. Deep brain stimulation for severe OCD was introduced as an alternative to ablation neurosurgery but the optimal target for electrode placement remains under debate and will be discussed with reference to a study directly comparing DBS of two emerging targets within the same patients. Finally, methods of target refinement will be discussed which may improve patients outcome in the near future.

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