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Neurosurgical Review Jun 2023Neurosurgery is a therapeutic option for patients with refractory obsessive-compulsive disorder who do not respond to previous treatments. Although its efficacy in... (Review)
Review
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.
Topics: Humans; Neurosurgery; Neurosurgical Procedures; Obsessive-Compulsive Disorder; Psychosurgery; Treatment Outcome; Cognition
PubMed: 37351641
DOI: 10.1007/s10143-023-02037-w -
Revista de NeurologiaTo obtain an up to date review of the different possible surgical approaches in the management of certain psychiatric disorders that are refractory to conservative... (Review)
Review
AIMS
To obtain an up to date review of the different possible surgical approaches in the management of certain psychiatric disorders that are refractory to conservative treatment (pharmacotherapy, psychotherapy, electroconvulsive therapy).
METHOD
In order to conduct this research we reviewed the work published by centres with the most experience in this type of surgery, mainly in North America and Europe, since its beginnings in the 1930s, with the controversy concerning prefrontal leucotomy, until the appearance of modern stereotactic techniques. We analyse the anatomophysiological bases, their main clinical indications, the surgical techniques used and their results, as well as perspectives for the future of this neurosurgical treatment.
CONCLUSIONS
The most noteworthy progress in psychosurgery in recent years has been the combination of a more rigorous selection of patients and the higher degree of specificity with which treatment is performed on the brain structures involved in psychiatric disease. The most widely employed psychosurgical procedures at present are cingulotomy, anterior capsulotomy, subcaudate tractotomy, limbic leucotomy and postero medial hypothalamotomy, with favourable responses in about 35 70% of cases. The psychiatric diagnoses where the best results are to be found are obsessive compulsive disorder, chronic anxiety states and major depression. Current progress in neuroimaging techniques, increased neurophysiological knowledge and the revolutionary neuromodulation techniques, especially deep brain stimulation, offer an even more promising future for psychiatric neurosurgery.
Topics: Brain; Caudate Nucleus; Electric Stimulation Therapy; Gyrus Cinguli; Humans; Hypothalamus; Internal Capsule; Limbic System; Mental Disorders; Obsessive-Compulsive Disorder; Psychosurgery; Stereotaxic Techniques
PubMed: 12717678
DOI: No ID Found -
CNS Neuroscience & Therapeutics Aug 2019Patients with epilepsy and refractory comorbid psychiatric disorders often experience functional impairments and a lower quality of life as well as showing a lack of...
OBJECTIVES
Patients with epilepsy and refractory comorbid psychiatric disorders often experience functional impairments and a lower quality of life as well as showing a lack of compliance with anti-epileptic medication regimens. We reasoned that widespread clinical benefits could be gained if the psychiatric comorbidities among these patients were reduced. In this study, we assessed the utility of anterior capsulotomy in managing medication-refractory comorbid psychotic symptoms and aggression in patients with epilepsy.
METHODS
In this retrospective case series, we evaluated the clinical outcomes of 13 epilepsy patients with severe psychiatric comorbidities who had received bilateral anterior capsulotomy. Clinical outcome assessments were performed at 1 week, 6 months, 1 year, and several years after surgery focusing on: (a) severity of psychotic symptoms, as assessed by the 18-item Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale; (b) severity of impulsivity and aggression, measured by the Barratt Impulsiveness Scale-11 and the Buss-Perry Aggression Scale; and (c) social function and quality of life, assessed by the Social Disability Screening Scale and the Quality of Life in Epilepsy.
RESULTS
After anterior capsulotomy, patients displayed significant improvements of psychotic symptoms, as well as of impulsivity and aggression, along with improvements of social function and quality of life. The clinical benefits to patients were evident within 6 months after surgery and remained stable or continued to improve at a much slower rate thereafter. Furthermore, after anterior capsulotomy all patients complied with epilepsy interventions that they did not comply with prior to surgery. No significant side effects or complications occurred during the study.
CONCLUSION
Anterior capsulotomy seems to be a safe and effective treatment for epilepsy patients with otherwise intractable comorbid psychotic symptoms and aggression. Moreover, this neurosurgical treatment may improve the patients' social function, quality of life, and compliance with anti-epilepsy medication regimens.
Topics: Adolescent; Adult; Aggression; Comorbidity; Epilepsy; Female; Humans; Internal Capsule; Male; Medication Adherence; Psychotic Disorders; Quality of Life; Retrospective Studies; Young Adult
PubMed: 30868752
DOI: 10.1111/cns.13118 -
Cell Reports Jul 2018Investigations of functional (re)organization in children who have undergone large cortical resections offer a unique opportunity to elucidate the nature and extent of...
Investigations of functional (re)organization in children who have undergone large cortical resections offer a unique opportunity to elucidate the nature and extent of cortical plasticity. We report findings from a 3-year investigation of a child, U.D., who underwent surgical removal of the right occipital and posterior temporal lobes at age 6 years 9 months. Relative to controls, post-surgically, U.D. showed age-appropriate intellectual performance and visuoperceptual face and object recognition skills. Using fMRI at five different time points, we observed a persistent hemianopia and no visual field remapping. In category-selective visual cortices, however, object- and scene-selective regions in the intact left hemisphere were stable early on, but regions subserving face and word recognition emerged later and evinced competition for cortical representation. These findings reveal alterations in the selectivity and topography of category-selective regions when confined to a single hemisphere and provide insights into dynamic functional changes in extrastriate cortical architecture.
Topics: Child; Cognition; Drug Resistant Epilepsy; Facial Recognition; Humans; Language; Magnetic Resonance Imaging; Male; Neuronal Plasticity; Psychosurgery; Temporal Lobe; Visual Cortex
PubMed: 30067969
DOI: 10.1016/j.celrep.2018.06.099 -
Postgraduate Medical Journal Dec 1973The requirements for modern psychosurgery are safety and accuracy. Stereotactic techniques give the geometric accuracy and stimulation gives physiological information,...
The requirements for modern psychosurgery are safety and accuracy. Stereotactic techniques give the geometric accuracy and stimulation gives physiological information, which is important in determining lesion sites or at least lesion symmetry. The process whereby focal brain destruction is produced is ideally by a freezing probe, but equally effectively by coagulation. A number of small lesions is thus required. This at present is unavoidable if side effects are to be obviated. Careful continuing assessment of results is necessary to validate any surgical procedure.
Topics: Cryosurgery; Humans; Limbic System; Psychosurgery; Stereotaxic Techniques
PubMed: 4618905
DOI: 10.1136/pgmj.49.578.860 -
Stereotactic and Functional Neurosurgery 2017Stereotactic anterior cingulotomy has been used in the treatment of patients suffering from refractory oncological pain due to its effects on pain perception. However,...
BACKGROUND
Stereotactic anterior cingulotomy has been used in the treatment of patients suffering from refractory oncological pain due to its effects on pain perception. However, the optimal targets as well as suitable candidates and outcome measures have not been well defined. We report our initial experience in the ablation of 2 cingulotomy targets on each side and the use of the Brief Pain Inventory (BPI) as a perioperative assessment tool.
METHODS
A retrospective review of all patients who underwent stereotactic anterior cingulotomy in our Department between November 2015 and February 2017 was performed. All patients had advanced metastatic cancer with limited prognosis and suffered from intractable oncological pain.
RESULTS
Thirteen patients (10 women and 3 men) underwent 14 cingulotomy procedures. Their mean age was 54 ± 14 years. All patients reported substantial pain relief immediately after the operation. Out of the 6 preoperatively bedridden patients, 3 started ambulating shortly after. At the 1-month follow-up, the mean preoperative Visual Analogue Scale score decreased from 9 ± 0.9 to 4 ± 2.7 (p = 0.003). Mean BPI pain severity and interference scores decreased from levels of 29 ± 4 and 55 ± 12 to 16 ± 12 (p = 0.028) and 37 ± 15 (p = 0.043), respectively. During the 1- and 3-month follow-up visits, 9/11 patients (82%) and 5/7 patients (71%) available for follow-up reported substantial pain relief. No patient reported worsening of pain during the study period. Neuropsychological analyses of 6 patients showed stable cognitive functions with a mild nonsignificant decline in focused attention and executive functions. Adverse events included transient confusion or mild apathy in 5 patients (38%) lasting 1-4 weeks.
CONCLUSIONS
Our initial experience indicates that double stereotactic cingulotomy is safe and effective in alleviating refractory oncological pain.
Topics: Adult; Aged; Cancer Pain; Cognition; Female; Follow-Up Studies; Gyrus Cinguli; Humans; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Middle Aged; Pain Management; Pain, Intractable; Psychosurgery; Retrospective Studies; Stereotaxic Techniques
PubMed: 29316566
DOI: 10.1159/000484613 -
Frontiers in Integrative Neuroscience 2011Deep brain stimulation (DBS) is currently used to treat neurological disorders like Parkinson's disease, essential tremor, and dystonia, and is explored as an...
Deep brain stimulation (DBS) is currently used to treat neurological disorders like Parkinson's disease, essential tremor, and dystonia, and is explored as an experimental treatment for psychiatric disorders like major depression and obsessive compulsive disorder. This mini review discusses ethical issues in DBS treatment and research, as they have been discussed in the medical and ethical literature. With regard to DBS treatment, the most important issues are balancing risks and benefits and ensuring respect for the autonomous wish of the patient. This implies special attention to patient selection, psycho-social impact of treatment, effects on personal identity, and treatment of children. Moreover, it implies a careful informed consent process in which unrealistic expectations of patients and their families are addressed and in which special attention is given to competence. In the context of research, the fundamental ethical challenge is to promote high-quality scientific research in the interest of future patients, while at the same time safeguarding the rights and interests of vulnerable research subjects. Several guidelines have been proposed to ensure this. One of the preconditions to further development of responsible and transparent research practices is the establishment of a comprehensive registry.
PubMed: 21625629
DOI: 10.3389/fnint.2011.00017 -
Stereotactic and Functional Neurosurgery 2014
Topics: Ablation Techniques; Electrophysiological Phenomena; Female; Humans; Male; Neurosurgical Procedures; Nucleus Accumbens; Stereotaxic Techniques
PubMed: 24943830
DOI: 10.1159/000360707 -
Journal of Psychiatric Research Jun 2020Stereotactic ablation (cingulotomy) and subcallosal cingulate deep brain stimulation (SCC DBS) of different regions of the cingulum bundle (CB) have been successfully...
OBJECTIVE
Stereotactic ablation (cingulotomy) and subcallosal cingulate deep brain stimulation (SCC DBS) of different regions of the cingulum bundle (CB) have been successfully used to treat psychiatric disorders, such as depression and bipolar disorder. They are hypothesized to work by disrupting white matter pathways involved in the clinical manifestation of these disorders. This study aims to compare the connectivity of different CB subregions using tractography to evaluate stereotactic targets for the treatment of mood disorders.
METHODS
Fourteen healthy volunteers underwent 3T-MR imaging followed by connectivity analysis using probabilistic tractography. Twenty-one anatomic regions of interest were defined for each subject: 10 CB subregions (including the classical cingulotomy and SCC DBS targets) and 11 cortical/subcortical structures implicated in mood disorders. Connectivity results were compared using Friedman and Bonferroni-corrected post-hoc Wilcoxon tests.
RESULTS
CB connectivity showed a high degree of regional specificity. Both of the traditional stereotactic targets had widespread connectivity with discrete topology. The cingulotomy target connected primarily to the dorsomedial frontal, dorsal anterior cingulate, and posterior cingulate cortices, whereas the SCC DBS target connected mostly to the subgenual anterior cingulate and medial/central orbitofrontal cortices. However, a region of the rostral dorsal CB, lying between these surgical targets, encompassed statistically equivalent connections to all five cortical regions.
CONCLUSIONS
The CB is associated with brain structures involved in affective disorders, and the rostral dorsal CB demonstrates connectivity that is comparable to the combined connectivity of cingulotomy and SCC DBS neurosurgical interventions. The rostral dorsal CB represents a surgical target worthy of clinical exploration for mood disorders.
Topics: Brain; Deep Brain Stimulation; Gyrus Cinguli; Humans; Mood Disorders; White Matter
PubMed: 32272241
DOI: 10.1016/j.jpsychires.2020.03.011 -
California Medicine Jul 1973
Review
Topics: Anticonvulsants; Brain Neoplasms; Diazepam; Electroencephalography; Epilepsy; Epilepsy, Temporal Lobe; Humans; Mephobarbital; Phenobarbital; Phenytoin; Psychosurgery; United States
PubMed: 4581416
DOI: No ID Found