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Open Access 01-12-2023 | Obsessive-Compulsive Disorder | Review

Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review

Authors: G. Laseca-Zaballa, G. Lubrini, J. A. Periañez, V. Simón-Martínez, M. Martín Bejarano, C. Torres-Díaz, N. Martínez Moreno, J. Álvarez-Linera, R. Martínez Álvarez, M. Ríos-Lago

Published in: Neurosurgical Review | Issue 1/2023

Abstract

Neurosurgery is a therapeutic option for patients with refractory obsessive–compulsive disorder who do not respond to previous treatments. Although its efficacy in reducing clinical symptomatology has been proven, few studies have analyzed its effects at the cognitive level. The aim of this systematic review was to describe the cognitive outcomes of functional neurosurgery in patients that went through capsulotomies or cingulotomies. PubMed, Medline, Scopus, PsycInfo, PsyArticles, and Web of Knowledge were searched for studies reporting cognitive outcomes in refractory obsessive–compulsive patients after capsulotomies and cingulotomies. The risk of bias was assessed with the Assessment Tool for Before-After (Pre-Post) Studies With No Control Group tool; 13 studies met inclusion criteria, including 205 refractory obsessive–compulsive disorder patients for both surgical procedures. Results showed a substantial number of studies that did report significant cognitive improvement after surgery, being this improvement specially related to memory and executive functions. The second-most frequent finding is the maintenance of cognitive performance (nor improvement or worsening). From a neuropsychological point of view, this outcome might be considered a success, given that it is accompanied by amelioration of obsessive–compulsive symptoms. Subtle cognitive adverse effects have also been reported. Neurosurgery procedures appear to be safe from a cognitive point of view. Methodological issues must be improved to draw clearer conclusions, but capsulotomies and cingulotomies constitute an effective alternative treatment for refractory obsessive–compulsive disorder patients.

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Robbins TW, Vaghi MM, Banca P (2019) Obsessive-compulsive disorder: puzzles and prospects. Neuron 102:27–47. https://doi.org/10.1016/j.neuron.2019.01.046CrossRefPubMed

Stein DJ, Costa DLC, Lochner C, Miguel EC, Reddy YCJ, Shavitt RG, van den Heuvel OA, Simpson HB (2019) Obsessive-compulsive disorder Nat Rev Dis Primers 5:52. https://doi.org/10.1038/s41572-019-0102-3CrossRefPubMed

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Washington, DCCrossRef

Abramovitch A, Abramowitz JS, Mittelman A (2013) The neuropsychology of adult obsessive-compulsive disorder: a meta-analysis. Clin Psychol Rev 33:1163–1171. https://doi.org/10.1016/j.cpr.2013.09.004CrossRefPubMed

Shin NY, Lee TY, Kim E, Kwon JS (2014) Cognitive functioning in obsessive-compulsive disorder: a meta-analysis. Psychol Med 44:1121–1130. https://doi.org/10.1017/S0033291713001803CrossRefPubMed

Snyder HR, Kaiser RH, Warren SL, Heller W (2014) Obsessive-compulsive disorder is associated with broad impairments in executive function: a meta-analysis. Clin Psychol Sci 3:301–330. https://doi.org/10.1177/2167702614534210CrossRefPubMedCentral

Koran LM (2007) Obsessive-compulsive disorder: an update for the clinician. Focus 5:299–313. https://doi.org/10.1176/foc.5.3.foc299CrossRef

Baldwin DS, Anderson IM, Nutt DJ, Allgulander C, Bandelow B, den Boer JA, Christmas DM, Davies S, Fineberg N, Lidbetter N, Malizia A, McCrone P, Nabarro D, O’Neill C, Scott J, van der Wee N, Wittchen H (2014) Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J Psychopharmacol 28:403–439. https://doi.org/10.1177/0269881114525674CrossRefPubMed

Katzman MA, Bleau P, Chokka P, Kjernisted K, Van Ameringen M, The Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association Canadienne des troubles anxieux and McGill University (2014) The Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry 14:S1. https://doi.org/10.1186/1471-244X-14-S1-S1CrossRefPubMedPubMedCentral

10.

National Institute for Health and Care Excellence (NICE) (2005) Obsessive-compulsive disorder and body dysmorphic disorder: treatment. https://www.nice.org.uk/guidance/cg31

11.

National Institute for Health and Care Excellence (NICE) (2013) Obsessive-compulsive disorder. Evidence Update September 2013. https://www.nice.org.uk/guidance/cg31/evidence/evidence-update-194847085

12.

Drubach DA (2015) Obsessive-compulsive disorder. Continuum (Minneap Minn) 21:783–788. https://doi.org/10.1212/01.CON.0000466666.12779.07CrossRefPubMed

13.

Pozza A, Dèttore D (2017) Drop-out and efficacy of group versus individual cognitive behavioral therapy: what works best for obsessive-compulsive disorder? A systematic review and meta-analysis of direct comparisons. Psychiatry Res 258:24–36. https://doi.org/10.1016/j.psychres.2017.09.056CrossRefPubMed

14.

Miguel EC, Lopes AC, McLaughlin NCR, Norén G, Gentil AF, Hamani C, Shavitt RG, Matustuzzo MC, Vattimo EFQ, Canteras M, De Salles A, Gorgulho A, Salvajoli JV, Fonoff ET, Paddich I, Hoexter MQ, Lingquist C, Haber SN, Greenberg BD, Sheth SA (2018) Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder. Mol Psychiatry 24:218–240. https://doi.org/10.1038/s41380-018-0054-0CrossRefPubMedPubMedCentral

15.

Sinha S, McGovern RA, Mikell CB, Banks GP, Sheth SA (2015) Ablative limbic system surgery: review and future directions. Curr Behav Neurosci Rep 2:49–59. https://doi.org/10.1007/s40473-015-0038-1CrossRefPubMedPubMedCentral

16.

Martínez-Álvarez R (2019) Radiosurgery for behavioral disorders. Prog Neurol Surg 34:289–297. https://doi.org/10.1159/000493076CrossRefPubMed

17.

Greenberg BD, Rauch SL, Haber SN (2010) Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology 35:317–336. https://doi.org/10.1038/npp.2009.128CrossRefPubMed

18.

Jung HH, Chang WS, Kim SJ, Kim C, Chang JW (2018) The potential usefulness of magnetic resonance guided focused ultrasound for obsessive compulsive disorders. J Korean Neurosurg Soc 61:427–433. https://doi.org/10.3340/jkns.2017.0505.004CrossRefPubMedPubMedCentral

19.

Levequé M (2014) Psychosurgery. Springer International Publishing, Switzerland, New techniques for brain disordersCrossRef

20.

Martínez-Álvarez R (2014) Ablative surgery for obsessive-compulsive disorders. In: Sun B, De Salles A (eds) Neurosurgical Treatments for Psychiatric Disorders. Springer, Dordrecht, Shanghai, China, pp 105–112

21.

Staudt MD, Herring EZ, Gao K, Miller JP, Sweet JA (2019) Evolution in the treatment of psychiatric disorders: from psychosurgery to psychopharmacology to neuromodulation. Front Neurosci 13:108. https://doi.org/10.3389/fnins.2019.00108CrossRefPubMedPubMedCentral

22.

Dougherty DD, Baer L, Cosgrove GR, Cassem EH, Price BH, Nierenberg AA, Jenike MA, Rauch SL (2002) Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry 159:269–275. https://doi.org/10.1176/appi.ajp.159.2.269CrossRefPubMed

23.

Spatolla G, Martinez-Alvarez R, Martinez-Moreno N, Rey G, Linera J, Rios-Lago M, Sanz M, Gutiérrez J, Vidal P, Richieri R, Régis J (2018) Results of Gamma Knife anterior capsulotomy for refractory obsessive-compulsive disorder: results in a series of 10 consecutive patients. J Neurosurg 131:376–383. https://doi.org/10.3171/2018.4.JNS171525CrossRef

24.

Pepper J, Zrinzo L, Hariz M (2019) Anterior capsulotomy for obsessive-compulsive disorder: a review of old and new literature. J Neurosurg 11:1–10. https://doi.org/10.3171/2019.4.JNS19275CrossRef

25.

Brown LT, Mikell CB, Youngerman BE, Zhang Y, McKhann GM, Sheth SA (2016) Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: a systematic review of observational studies. J Neurosurg 124:77–89. https://doi.org/10.3171/2015.1.JNS14681CrossRefPubMed

26.

Kumar KK, Bhati MT, Ravikumar VK, Ghanouni P, Stein SC, Halpern CH (2019) MR-guided focused ultrasound versus radiofrequency capsulotomy for treatment-refractory obsessive-compulsive disorder: a cost-effectiveness threshold analysis. Front Neurosci 13:66. https://doi.org/10.3389/fnins.2019.00066CrossRefPubMedPubMedCentral

27.

Lezak M, Howieson DB, Bigler ED, Tranel D (2012) Neuropsychological assesment. Oxford University Press, New York

28.

Lai Y, Wang T, Zhang C, Lin G, Voon V, Chang J, Sun B (2020) Effectiveness and safety of neuroablation for severe and treatment-resistant obsessive-compulsive disorder: a systematic review and meta-analysis. J Psychiatry Neurosci 45:356–369. https://doi.org/10.1503/jpn.190079CrossRefPubMedPubMedCentral

29.

Liberati A, Altman DG, Tetzlaff J, Mulrow C, Getzsche PC, Ionnidis JPA, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Plos Med 6:e1000100. https://doi.org/10.1371/journal.pmed.1000100CrossRefPubMedPubMedCentral

30.

Moher D, Liberati A, Tetzlaff J, Altman DG, the PRISMA group (2009) Prefered reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 21:e1000097. https://doi.org/10.1371/journal.pmed.1000097CrossRef

31.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71CrossRefPubMedPubMedCentral

32.

National Heart, Lung and Blood Institute (NIH) (2021) Study quality assessment tools. https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools

33.

Ma L, Wang Y, Yang Z, Huang D, Weng H, Zeng X (2020) Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better? Mil Med Res 7:7. https://doi.org/10.1186/s40779-020-00238-8CrossRefPubMedPubMedCentral

34.

Kreutzer JS, DeLuca J, Caplan B (2018) Encyclopedia of clinical neuropsychology. Springer Intenational Publishing, SwitzerlandCrossRef

35.

Strauss E, Sherman E, Spreen O (2006) A compendium of neuropsychological tests. Oxford University Press, New York

36.

Sánchez-Cubillo I, Periañez JA, Adrover-Roig D, Rodríguez-Sánchez JM, Ríos-Lago M, Tirapu J, Barceló F (2009) Construct validity of the trail making test: role of task-switching, working memory, inhibition/interference control, and visuomotor abilities. J Int Neuropsychol Soc 15:438–450. https://doi.org/10.1017/S1355617709090626CrossRefPubMed

37.

Periañez JA, Lubrini G, García-Gutiérrez A, Ríos-Lago M (2020) Construct validity of the stroop color-word test: influence of speed of visual search, verbal fluency, working memory, cognitive flexibility, and conflict monitoring. Arch Clin Neuropsychol 36:99–111. https://doi.org/10.1093/arclin/acaa034CrossRef

38.

Sj K, Roh D, Jung HH, Chang WS, Kim C, Chang JW (2018) A study of novel bilateral thermal capsulotomy with focused ultrasound for treatment-refractory obsessive-compulsive disorder: 2-year follow-up. J Psychiatry Neurosci 43:327–337. https://doi.org/10.1503/jpn.170188CrossRef

39.

Gong F, Li P, Li B, Zhang S, Zhang X, Yang S, Liu H, Wang W (2018) A study of cognitive function in treatment-refractory obsessive-compulsive disorder treated with capsulotomy. J Neurosurg 128:583–595. https://doi.org/10.3171/2016.9.JNS152494CrossRefPubMed

40.

Batistuzzo MC, Hoexter MQ, Taub A, Gentil AF, Cesar RCC, Joaquim MA, D’Alcante MA, McLaughlin NC, Canteras MM, Shavitt RG, Savage CR, Greenberg BD, Norén G, Miguel EC, Lopes AC (2015) Visuospatial memory improvement after gamma ventral capsulotomy in treatment refractory obsessive-compulsive disorder patients. NPP 40:1837–1845. https://doi.org/10.1038/npp.2015.33CrossRef

41.

Krámska L, Urgošik D, Liščák R, Hrešková L, Skopová J (2021) Neuropsychological outcome in refractory obsessive-compulsive disorder treated with anterior capsulotomy including repeated surgery. Psychiatry Clin Neurosci 75:101–197. https://doi.org/10.1111/pcn.13190CrossRefPubMedPubMedCentral

42.

Csigó K, Harsányi A, Demeter G, Cs R, Németh A, Racsmány M (2010) Long-term follow-up of patients with obsessive-compulsive disorder treated by anterior capsulotomy: a neuropsychological study. J Affect Disord 126:198–205. https://doi.org/10.1016/j.jad.2010.02.127CrossRefPubMed

43.

Fodstad H, Strandman E, Karlsson B, West KA (1982) Treatment of chronic obsessive compulsive states with stereotactic anterior capsulotomy or cingulotomy. Acta Neurochir Suppl 62:1–23. https://doi.org/10.1007/BF01402207CrossRef

44.

Jung HH, Kim SJ, Roh D, Chang JG, Chang WS, Kweon EJ, Kim C, Chang JW (2015) Bilateral thermal capsulotomy with MR-guided focused ultrasound for patients with treatment-refractory obsessive-compulsive disorder: a proof-of-concept study. Mol Psychiatry 20:1205–1211. https://doi.org/10.1038/mp.2014.154CrossRefPubMed

45.

Peker S, Yavuz M, Yilmaz M, Sengoz M, Ulku N, Ogel K (2020) Efficacy and safety of gamma ventral capsulotomy for treatment-resistant obsessive-compulsive disorder: a single-center experience. World Neurosurg 141:e941–e952. https://doi.org/10.1016/j.wneu.2020.06.098CrossRefPubMed

46.

Oliver B, Gascón J, Aparicio A, Ayats E, Rodríguez R, Maestro de León JL, García-Bach M, Anton Soler P (2003) Bilateral anterior capsulotomy for refractory obsessive-compulsive disorders. Stereotact Funct Neurosurg 81:90–95. https://doi.org/10.1159/000075110CrossRefPubMed

47.

Rück C, Karlsson A, Steele D, Edman G, Meyerson BA, Ericson K, Nyman H, Åsberg M, Svanborg P (2008) Capsulotomy for obsessive-compulsive disorder. Long-term follow-up of 25 patients. Arch Gen Psychiatry 65:914–922. https://doi.org/10.1001/archpsyc.65.8.914CrossRefPubMed

48.

Zhan S, Liu W, Li D, Pan S, Pan Y, Li Y, Sun B (2014) Long-term follow-up of bilateral anterior capsulotomy in patients with refractory obsessive-compulsive disorder. Clin Neurol Neurosurg 119:91–95. https://doi.org/10.1016/j.clineuro.2014.01.009CrossRefPubMed

49.

Kassel MT, Lositsky O, Vaidya AR, Badre D, Malloy PF, Greenberg BD, Marsland R, Noren G, Sherman A, Rasmussen SA, McLaughlin NCR (2022) Differential assessment of frontally-mediated behaviors between self- and informant-report in patients with obsessive-compulsive disorder following gamma ventral capsulotomy. Neuropsychologia 170:108211. https://doi.org/10.1016/j.neuropsychologia.2022.108211CrossRefPubMedPubMedCentral

50.

Jung HH, Kim C, Chang JH, Park YG, Chung SS, Chang JW (2006) Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: long-term follow-up results. Stereotact Funct Neurosurg 84:184–189. https://doi.org/10.1159/000095031CrossRefPubMed

51.

Saxena S, Brody AL, Schwartz JM, Baxter LR (1998) Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry Suppl 35:26–37. https://doi.org/10.1192/S0007125000297870CrossRef

52.

Chamberlain SR, Blackwell AD, Fineberg NA, Robbins TW, Sahakian BJ (2005) The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioral inhibition as candidate endophenotypic markers. Neurosci Biobehav Rev 29:399–419. https://doi.org/10.1016/j.neubiorev.2004.11.006CrossRefPubMed

53.

Menzies L, Chamberlain SR, Laird AR, Thelen SM, Sahakian BJ, Bullmore ET (2008) Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev 32:525–549. https://doi.org/10.1016/j.neubiorev.2007.09.005CrossRefPubMed

54.

Oliveira BF, Gorgulho A, Saraiva CWC, Lopes AC, Ribeiro JG, Pássaro AM, Hoexter MQ, Miguel EC, De Salles AEF (2019) Understanding gamma ventral capsulotomy: potential implications of difusión tensor image tractography on target selectivity. Surg Neurol Int 10:136. https://doi.org/10.25259/SNI-65-2019CrossRef

55.

Savage CR (1998) Neuropsychology of obsessive-compulsive disorder: research findings and treatment implications. In: Jenike M, Baer L, Minichiello W (eds) Obsessive-compulsive disorders: practical management, 3rd edn. Mosby, St.Louis, MO, pp 254–275

56.

Shepard E, Stern ER, van den Heuvel OA, Costa DLC, Batistuzzo MC, Godoy PBG, Lopes AC, Brunoni AR, Hoexter MQ, Shavitt RG, Reddy YCJ, Lochner C, Stein DJ, Simpson HB, Miguel EC (2021) Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder. Mol Psychiatry 26:4583–4604. https://doi.org/10.1038/s41380-020-01007-8CrossRef

57.

Hartlage S, Alloy LB, Vázquez C, Dykman B (1993) Automatic and effortful processing in depression. Psychol Bull 113:247–278. https://doi.org/10.1037/0033-2909.113.2.247CrossRefPubMed

58.

Nuño L, Gómez-Benito J, Carmona VR, Pino O (2021) A systematic review of executive function and information processing speed in major depression disorder. Brain Sci 11:147. https://doi.org/10.3390/brainsci11020147CrossRefPubMedPubMedCentral

59.

Avecillas JM, Hurwitz TA, Bogod NM, Honey CR (2021) Tractography-guided anterior capsulotomy for major depression and obsessive-compulsive disorder: targeting the emotion network. Oper Neurosurg (Hagerstown) 20:406–412. https://doi.org/10.1093/ons/opaa420CrossRef

60.

Kim CH, Chang JW, Koo M, Kim JW, Suh HS, Park IH, Hs L (2003) Anterior cingulotomy for refractory obsessive-compulsive disorder. Acta Psychiatr Scand 107:283–290. https://doi.org/10.1034/j.1600-0447.2003.00087.xCrossRefPubMed

61.

Heaton, RK (1981) Wisconsin card sorting test manual. Psychological Association Resources, Odessa

62.

Diamond A (2013) Executive functions. Annu Rev Psychol 64:135–168. https://doi.org/10.1146/annurev-psych-113011-143750CrossRefPubMed

63.

McGovern RA, Sameer S (2017) Role of the dorsal anterior cingulate in obsessive-compulsive disorder: converging evidence from cognitive neuroscience and psychiatric neurosurgery. J Neurosurg 126(1):132–147. https://doi.org/10.3171/2016.1.JNS15601CrossRefPubMed

64.

Gehring WJ, Himle J, Nisenson LG (2000) Action-monitoring dysfunction in obsessive-compulsive disorder. Psychol Sci 11(1):1–6. https://doi.org/10.1111/1467-9280.00206CrossRefPubMed

65.

Beckman M, Johansen Berg H, Rushworth MF (2009) Connectivity-based parcellation of human cingulate cortex and its relation to functional specialization. J Neurosci 29:1175–1190. https://doi.org/10.1523/JNEUROSCI.3328-08.2009CrossRef

66.

Bubb EJ, Metzler-Baddeley C, Aggleton JP (2018) The cingulum bundle: anatomy, function, and dysfunction. Neurosci Biobehav Rev 92:104–127. https://doi.org/10.1016/j.neubiorev.2018.05.008CrossRefPubMedPubMedCentral

67.

Bragdon LB, Gibb BE, Coles ME (2017) Does neuropsychological performance in OCD relate to different symptoms? A meta-analysis comparing the symmetry and obsessing dimensions. Depress Anxiety 35:761–774. https://doi.org/10.1002/da.22785CrossRef

68.

Gong F, Li B, Zhang S, Wang Y, Gao Y, Xu Y, Wang X, Xiong B, Li D, Wen R, Qin Z, Wang W (2019) The suitability of different subtypes and dimensions of obsessive-compulsive disorder for treatment with anterior capsulotomy: a long-term follow-up study. Stereotact Funct Neurosurg 97:319–336. https://doi.org/10.1159/000500137CrossRefPubMed

69.

Overdorp EJ, Kessels RPC, Claassen JA, Oosterman JM (2016) The combined effect of neuropsychological and neuropathological deficits on instrumental activities of daily living in older adults: a systematic review. Neuropsychol Rev 26:92–106. https://doi.org/10.1007/s11065-015-9312-yCrossRefPubMedPubMedCentral

70.

Nuttin B, Wu G, Mayberg H, Hariz M, Gabriëls L, Galert T, Merkel R, Kubu C, Vilela-Filho O, Matthews K, Taira T, Lozano AM, Schechtmann G, Doshi P, Broggi G, Régis J, Alkhani A, Sin B, Elijamel S, Schulder M, Kaplitt M, Eskandar E, Rezai A, Krauss JK, Hilven P, Schuurman R, Ruiz P, Chang JW, Cosyns P, Lipsman N, Voges J, Cosgrove R, Li Y, Schlaepfer T (2014) Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry 85:1003–1008. https://doi.org/10.1136/jnnp-2013-306580CrossRefPubMed

Title: Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review
Authors: G. Laseca-Zaballa
G. Lubrini
J. A. Periañez
V. Simón-Martínez
M. Martín Bejarano
C. Torres-Díaz
N. Martínez Moreno
J. Álvarez-Linera
R. Martínez Álvarez
M. Ríos-Lago
Publication date: 01-12-2023
Publisher: Springer Berlin Heidelberg
Keyword: Obsessive-Compulsive Disorder
Published in: Neurosurgical Review / Issue 1/2023
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-023-02037-w

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cognitive outcomes following functional neurosurgery in refractory OCD patients: a systematic review

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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