Efficacy, management of adverse effects and relapse forms after obsessive-compulsive disorder surgery: The first Egyptian and Arab cohort

Background: The aim of this study was to investigate the outcome of neurosurgery for mental illness in a cohort of Egyptian/Arab patients with treatment-resistant obsessive-compulsive disorder (OCD). Methods: Sixteen patients were recruited from various psychiatric clinics. All participants met DSM-5 criteria for OCD and had failed extensive trials of psychiatric medications and psychotherapies. Eligibility criteria focused on significant distress and functional impairment, as well as a Yale-Brown Obsessive Compulsive Scale (YBOCS) score greater than 30. Patients underwent either cingulotomy or capsulotomy and were followed monthly beginning immediately after surgery. Follow-up assessment evaluated OCD symptom severity, depression, anxiety, functional status, and both immediate and delayed postoperative adverse effects. Results: At the most recent follow-up (median: 19, range: 6 months – 25 months), 56.25% (9/16) of patients achieved at least a partial response, including 8 responders and 1 partial responder. Significant reductions in YBOCS, Beck Depression Inventory (BDI), and Hamilton Anxiety Rating Scale scores were recorded, suggesting that psychosurgery may be associated with improvement in OCD symptoms. However, because this was a noncontrolled study, causality between surgery and clinical improvement cannot be established. Immediate adverse effects were mild, transient, and observed in 37.5% (6/16) of patients. Delayed adverse effects were reported by 68.75% (11/16) of the total cohort and were predominantly characterized by recurrence of the initial OCD symptoms (9/16), often accompanied by depressive symptoms. Notably, two-thirds of patients who experienced symptom relapse were subsequently managed successfully with pharmacotherapy and behavioral therapy. Conclusion: Both cingulotomy and capsulotomy may be associated with significant reductions in OCD symptom severity, as well as improvements in depression and anxiety among patients with treatment-resistant OCD. Although relapse of OCD symptoms during follow-up was common, close monthly monitoring immediately after surgery and ongoing management were effective in restoring clinical improvement in many patients. As the first study of its kind conducted in Egypt and the Arab world, these findings also highlight the unique cultural challenges encountered in introducing psychiatric surgery within this setting.