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Neuroscience and Biobehavioral Reviews Nov 2021Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Chronic pain, with a prevalence of 20-30 % is the major cause... (Review)
Review
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Chronic pain, with a prevalence of 20-30 % is the major cause of human suffering worldwide, because effective, specific and safe therapies have yet to be developed. It is unevenly distributed among sexes, with women experiencing more pain and suffering. Chronic pain can be anatomically and phenomenologically dissected into three separable but interacting pathways, a lateral 'painfulness' pathway, a medial 'suffering' pathway and a descending pain inhibitory pathway. One may have pain(fullness) without suffering and suffering without pain(fullness). Pain sensation leads to suffering via a cognitive, emotional and autonomic processing, and is expressed as anger, fear, frustration, anxiety and depression. The medial pathway overlaps with the salience and stress networks, explaining that behavioural relevance or meaning determines the suffering associated with painfulness. Genetic and epigenetic influences trigger chronic neuroinflammatory changes which are involved in transitioning from acute to chronic pain. Based on the concept of the Bayesian brain, pain (and suffering) can be regarded as the consequence of an imbalance between the two ascending and the descending pain inhibitory pathways under control of the reward system. The therapeutic clinical implications of this simple pain model are obvious. After categorizing the working mechanisms of each of the available treatments (pain killers, psychopharmacology, psychotherapy, neuromodulation, psychosurgery, spinal cord stimulation) to 1 or more of the 3 pathways, a rational combination can be proposed of activating the descending pain inhibitory pathway in combination with inhibition of the medial and lateral pathway, so as to rebalance the pain (and suffering) pathways.
Topics: Anxiety; Bayes Theorem; Brain; Chronic Pain; Female; Humans; Pain Perception
PubMed: 34411559
DOI: 10.1016/j.neubiorev.2021.08.013 -
Progress in Brain Research 2022Making lesions in the brain to relieve the distress of mental illness has had a checkered career due to a mixture of misuse and also caution about making permanent...
Making lesions in the brain to relieve the distress of mental illness has had a checkered career due to a mixture of misuse and also caution about making permanent lesions in the brain where there was no physical abnormality. However, over the last 10 years a more flexible approach has developed. The method is still in its infancy and very little used. However, GKNS has been shown to be useful for OCD and also some cases of sever anxiety. It has been attempted for depression and anorexia nervosa but at present its role for these conditions remains to be determined.
Topics: Anxiety; Anxiety Disorders; Brain; Humans; Obsessive-Compulsive Disorder; Psychosurgery
PubMed: 35074092
DOI: 10.1016/bs.pbr.2021.10.043 -
Progress in Brain Research 2022Ethical problems of psychosurgery are debated since 1970s. The issues of informed consent, political and commercial abuses, lacking evidence and needed regulation are...
Ethical problems of psychosurgery are debated since 1970s. The issues of informed consent, political and commercial abuses, lacking evidence and needed regulation are overviewed. New surgical techniques provoke new discussions on goals and limits of psychosurgery.
Topics: Humans; Psychosurgery
PubMed: 35667803
DOI: 10.1016/bs.pbr.2022.03.004 -
Progress in Brain Research 2022The term "psychosurgery" reflecting neurosurgical treatment of mental disorders, was coined by a Portuguese neurologist Egas Moniz (1874-1955), who, in 1935, suggested a... (Review)
Review
The term "psychosurgery" reflecting neurosurgical treatment of mental disorders, was coined by a Portuguese neurologist Egas Moniz (1874-1955), who, in 1935, suggested a procedure named prefrontal leucotomy (or lobotomy) aimed to divide white matter tracts connecting prefrontal cortex and thalamus. Starting from 1936, this technique and its subsequent modification (transorbital lobotomy) was zealously promoted by a neurologist Walter Freeman (1895-1972) and a neurosurgeon James Watts (1904-1994) at George Washington University, who in 1942 summarized their experience in a monograph, which publication resulted in a tremendous worldwide interest in psychosurgical interventions. The present review describes comparative development of prefrontal leucotomy followed by stereotactic ablation and neurostimulation in three different geographical regions: USA, USSR/Russia, and Far East (China and Japan), where psychosurgery followed nearly similar courses, progressing from the initial enthusiasm and high clinical caseloads to nearly complete disregard. The opposition to neurosurgical interventions for mental disorders around the world was led by different groups and for varying reasons, but, unfortunately, always with political considerations mixed in. Today, with vast advancements in neuroimaging, stereotactic neurosurgical techniques, and physiological knowledge, psychiatric neurosurgery can be performed with much greater precision and safety.
Topics: Emotions; History, 20th Century; Humans; Mental Disorders; Neuroimaging; Prefrontal Cortex; Psychosurgery
PubMed: 35396022
DOI: 10.1016/bs.pbr.2021.12.003 -
Journal of Neuroimmunology Apr 2020Anti-GAD65 antibodies have been identified in both acute/subacute seizures (limbic encephalitis and extralimbic encephalitis) and chronic isolated epilepsy. The evidence... (Review)
Review
Anti-GAD65 antibodies have been identified in both acute/subacute seizures (limbic encephalitis and extralimbic encephalitis) and chronic isolated epilepsy. The evidence of high serum titers and intrathecal synthesis play a fundamental role in diagnosis but poorly correlate with disease severity or response to therapies. It remains controversial whether anti-GAD65 Abs are the pathogenic entity or only serve as a surrogate marker for autoimmune disorders mediated by cytotoxic T cells. Unlike other immune-mediated epilepsy, although multiple combinations of therapeutics are used, the efficacy and prognosis of patients with GAD65-epilepsy patients are poor. Besides, GAD65-epilepsy is more prone to relapse and potentially evolve into a more widespread CNS inflammatory disorder. This article reviews the recent advances of GAD65-epilepsy, focusing on the diagnosis, epidemiology, pathophysiology, clinical features, and treatment, to better promote the recognition and provide proper therapy for this condition.
Topics: Antibody Specificity; Autoantibodies; Autoantigens; Autoimmune Diseases of the Nervous System; Combined Modality Therapy; Disease Progression; Encephalitis; Epilepsy; Epitopes; Glutamate Decarboxylase; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Immunotherapy; Limbic Encephalitis; Models, Molecular; Neuroimaging; Paraneoplastic Syndromes, Nervous System; Plasmapheresis; Protein Conformation; Psychosurgery; T-Lymphocytes, Cytotoxic
PubMed: 32087461
DOI: 10.1016/j.jneuroim.2020.577189 -
The Journal of Legal Medicine 2019Following the rise and fall of lobotomy, a majority of U.S. states took legislative aim at psychosurgical procedures. This article canvasses, organizes, and analyzes the... (Review)
Review
Following the rise and fall of lobotomy, a majority of U.S. states took legislative aim at psychosurgical procedures. This article canvasses, organizes, and analyzes the existing body of United States statutes and regulations mentioning psychosurgery. Many states regulate psychosurgery without defining the term; existing definitions are imprecise, but many would arguably apply to contemporary procedures like deep brain stimulation. Common to many states are restrictions on surrogate consent to psychosurgery, codifications of patients' consent or refusal rights, and situation-specific bans on the practice targeting certain contexts of vulnerability. Many states have only a handful of scattered laws bearing on psychosurgery, but a few have wide-ranging and well-integrated regulatory regimes. In reviewing these laws we perceive much room for harmonization and modernization. Greater consistency in protecting vulnerable persons from troubling uses of psychosurgery is achievable even alongside an effort to remove undue legal obstacles impeding patient access to potentially therapeutic procedures. Our hope in surveying current psychosurgery law is to inaugurate a conversation on how best to shape its future.
Topics: Civil Rights; Humans; Informed Consent; Institutionalization; Legislation as Topic; Patient Rights; Psychosurgery; State Government; Treatment Refusal; United States; Vulnerable Populations
PubMed: 31940252
DOI: 10.1080/01947648.2019.1688208 -
Der Nervenarzt Mar 2021Rolf Hassler is one of the most renowned German specialists in psychiatry, neurology and neuroanatomy. Hassler's career exemplifies medicine as scientific endeavor.... (Review)
Review
Rolf Hassler is one of the most renowned German specialists in psychiatry, neurology and neuroanatomy. Hassler's career exemplifies medicine as scientific endeavor. Relaying on an expertise in neuroanatomy gained at Oscar and Cecile Vogt's Kaiser Wilhelm Institute, especially regarding the structure of the thalamus, Hassler enabled Freiburg University's neurosurgery clinic the invention of stereotactic "stepped leucotomy" and established thalamotomy internationally in a leading way. While directing the Neuroanatomical/Neurobiological department of the Max Planck Institute for Brain Research from 1959 until 1982, Hassler continued to study the effects of stimulation and targeted subcortical electrocoagulation in the cat brain. The Freiburg trained neurosurgeon Gert Dieckmann helped Hassler to apply the newly gained knowledge for the stereotactic therapy of torticollis, tics and obsessions and compulsions. The use however of thalamotomy also as a surgical therapy for aggressiveness in children, mainly during the late 1960s and early 1970s, is starting to provoke public criticism. Contrary however to the accusation of a medicine shaped by Nazi ideology into a "science without humanity", Hasslers career reveals a problematic intrinsic to medicine: the together of "art of healing and science".
Topics: Animals; Brain; Cats; National Socialism; Neuroanatomy; Neurology; Psychosurgery
PubMed: 32548758
DOI: 10.1007/s00115-020-00938-5 -
Neuropharmacology May 2020Approximately 20% of all epilepsy is caused by acute acquired injury such as traumatic brain injury, stroke and CNS infection. The known onset of the injury which... (Review)
Review
Approximately 20% of all epilepsy is caused by acute acquired injury such as traumatic brain injury, stroke and CNS infection. The known onset of the injury which triggers the epileptogenic process, early presentation to medical care, and a latency between the injury and the development of clinical epilepsy present an opportunity to intervene with treatment to prevent epilepsy. No such treatment exists and yet there has been remarkably little clinical research during the last 20 years to try to develop such treatment. We review possible reasons for this, possible ways to rectify the situations and note some of the ways currently under way to do so. Resective surgical treatment can achieve "cure" in some patients but is sparsely utilized. In certain "self-limiting" syndromes of childhood and adolescence epilepsy remits spontaneously. In a proportion of patients who become seizure free on medications or with dietary treatment, seizure freedom persists when treatment is discontinued. We discuss these situations which can be considered "cures"; and note that at present we have little understanding of mechanism of such cures, and cannot therefore translate them into a treatment paradigm targeting a "cure" of epilepsy. This article is part of the special issue entitled 'New Epilepsy Therapies for the 21st Century - From Antiseizure Drugs to Prevention, Modification and Cure of Epilepsy'.
Topics: Animals; Anticonvulsants; Brain Injuries, Traumatic; Clinical Trials as Topic; Diet, Ketogenic; Epilepsy; Humans; Psychosurgery; Stroke
PubMed: 31499048
DOI: 10.1016/j.neuropharm.2019.107762 -
Dementia & Neuropsychologia Dec 2020The case of Phineas Gage is an integral part of medical folklore. His accident still causes astonishment and curiosity and can be considered as the case that most...
The case of Phineas Gage is an integral part of medical folklore. His accident still causes astonishment and curiosity and can be considered as the case that most influenced and contributed to the nineteenth century's neuropsychiatric discussion on the mind-brain relationship and brain topography. It was perhaps the first case to suggest the role of brain areas in determining personality and which specific parts of the brain, when affected, can induce specific mental changes. In addition, his case contributed to the emergence of the scientific approaches that would later culminate in psychosurgery. Gage is a fixed element in the studies of neurology, psychology, and neuroscience, having been solidified as one of the greatest medical curiosities of all time, deserving its prominence.
PubMed: 33354296
DOI: 10.1590/1980-57642020dn14-040013 -
Advances and Technical Standards in... 2022In the surgery of gliomas, recent years have witnessed unprecedented theoretical and technical development, which extensively increased indication to surgery. On one... (Review)
Review
In the surgery of gliomas, recent years have witnessed unprecedented theoretical and technical development, which extensively increased indication to surgery. On one hand, it has been solidly demonstrated the impact of gross total resection on life expectancy. On the other hand, the paradigm shift from classical cortical localization of brain function towards connectomics caused by the resurgence of awake surgery and the advent of tractography has permitted safer surgeries focused on subcortical white matter tracts preservation and allowed for surgical resections within regions, such as Broca's area or the primary motor cortex, which were previously deemed inoperable. Furthermore, new asleep electrophysiological techniques have been developed whenever awake surgery is not an option, such as operating in situations of poor compliance (including paediatric patients) or pre-existing neurological deficits. One such strategy is the use of intraoperative neurophysiological monitoring (IONM), enabling the identification and preservation of functionally defined, but anatomically ambiguous, cortico-subcortical structures through mapping and monitoring techniques. These advances tie in with novel challenges, specifically risk prediction and the impact of neuroplasticity, the indication for tumour resection beyond visible borders, or supratotal resection, and most of all, a reappraisal of the importance of the right hemisphere from early psychosurgery to mapping and preservation of social behaviour, executive control, and decision making.Here we review current advances and future perspectives in a functional approach to glioma surgery.
Topics: Brain Mapping; Brain Neoplasms; Broca Area; Child; Glioma; Humans; Neurosurgical Procedures; Wakefulness
PubMed: 35976447
DOI: 10.1007/978-3-030-99166-1_2