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Cureus May 2024Obsessive-compulsive disorder (OCD) is a prevalent and debilitating mental health condition. This literature review examines the latest strategies in managing and... (Review)
Review
Obsessive-compulsive disorder (OCD) is a prevalent and debilitating mental health condition. This literature review examines the latest strategies in managing and treating OCD, with an emphasis on psychotherapy, pharmacological interventions, and neurosurgical options. A comprehensive literature search utilizing PubMed, Google Scholar, ClinicalKey, and Embase databases was conducted. Utilizing chosen keywords, the resulting articles were filtered based on inclusion and exclusion criteria. Included articles were used to discuss current research regarding OCD treatment and management. Findings reveal the efficacy and obstacles of treatments such as cognitive-behavioral therapy, selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and evidence-based neurosurgical methods, offering a broad perspective on OCD management. We discuss the limitations of these established treatments and examine the innovative response of neurosurgery in treating patients with OCD. This review highlights the importance of individualized treatment plans and areas for future research.
PubMed: 38883111
DOI: 10.7759/cureus.60496 -
Brain Stimulation 2023Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients....
Future directions in psychiatric neurosurgery: Proceedings of the 2022 American Society for Stereotactic and Functional Neurosurgery meeting on surgical neuromodulation for psychiatric disorders.
OBJECTIVE
Despite advances in the treatment of psychiatric diseases, currently available therapies do not provide sufficient and durable relief for as many as 30-40% of patients. Neuromodulation, including deep brain stimulation (DBS), has emerged as a potential therapy for persistent disabling disease, however it has not yet gained widespread adoption. In 2016, the American Society for Stereotactic and Functional Neurosurgery (ASSFN) convened a meeting with leaders in the field to discuss a roadmap for the path forward. A follow-up meeting in 2022 aimed to review the current state of the field and to identify critical barriers and milestones for progress.
DESIGN
The ASSFN convened a meeting on June 3, 2022 in Atlanta, Georgia and included leaders from the fields of neurology, neurosurgery, and psychiatry along with colleagues from industry, government, ethics, and law. The goal was to review the current state of the field, assess for advances or setbacks in the interim six years, and suggest a future path forward. The participants focused on five areas of interest: interdisciplinary engagement, regulatory pathways and trial design, disease biomarkers, ethics of psychiatric surgery, and resource allocation/prioritization. The proceedings are summarized here.
CONCLUSION
The field of surgical psychiatry has made significant progress since our last expert meeting. Although weakness and threats to the development of novel surgical therapies exist, the identified strengths and opportunities promise to move the field through methodically rigorous and biologically-based approaches. The experts agree that ethics, law, patient engagement, and multidisciplinary teams will be critical to any potential growth in this area.
Topics: Humans; United States; Neurosurgery; Deep Brain Stimulation; Neurosurgical Procedures; Mental Disorders; Psychosurgery
PubMed: 37217075
DOI: 10.1016/j.brs.2023.05.011 -
Acta Neurochirurgica Apr 2010Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5-10% of the general... (Review)
Review
INTRODUCTION
Major depressive disorder is one of the most disabling and common diagnoses amongst psychiatric disorders, with a current worldwide prevalence of 5-10% of the general population and up to 20-25% for the lifetime period.
HISTORICAL PERSPECTIVE
Nowadays, conventional treatment includes psychotherapy and pharmacotherapy; however, more than 60% of the treated patients respond unsatisfactorily, and almost one fifth becomes refractory to these therapies at long-term follow-up.
NONPHARMACOLOGICAL TECHNIQUES
Growing social incapacity and economic burdens make the medical community strive for better therapies, with fewer complications. Various nonpharmacological techniques like electroconvulsive therapy, vagus nerve stimulation, transcranial magnetic stimulation, lesion surgery, and deep brain stimulation have been developed for this purpose.
DISCUSSION
We reviewed the literature from the beginning of the twentieth century until July 2009 and described the early clinical effects and main reported complications of these methods.
Topics: Animals; Brain Mapping; Chronic Disease; Deep Brain Stimulation; Depressive Disorder, Major; Dominance, Cerebral; Electroconvulsive Therapy; Emotions; Humans; Outcome and Process Assessment, Health Care; Postoperative Complications; Prefrontal Cortex; Psychosurgery; Recurrence; Retreatment; Solitary Nucleus; Transcranial Magnetic Stimulation; Vagus Nerve; Vagus Nerve Stimulation
PubMed: 20101419
DOI: 10.1007/s00701-009-0589-6 -
Neuron Oct 2006In the 1960s, ablative stereotactic surgery was employed for a variety of movement disorders and psychiatric conditions. Although largely abandoned in the 1970s because... (Review)
Review
In the 1960s, ablative stereotactic surgery was employed for a variety of movement disorders and psychiatric conditions. Although largely abandoned in the 1970s because of highly effective drugs, such as levodopa for Parkinson's disease (PD), and a reaction against psychosurgery, the field has undergone a virtual renaissance, guided by a better understanding of brain circuitry and the circuit abnormalities underlying movement disorders such as PD and neuropsychiatric conditions, such as obsessive compulsive disorder. High-frequency electrical deep brain stimulation (DBS) of specific targets, introduced in the early 1990s for tremor, has gained widespread acceptance because of its less invasive, reversible, and adjustable features and is now utilized for an increasing number of brain disorders. This review summarizes the rationale behind DBS and the use of this technique for a variety of movement disorders and neuropsychiatric diseases.
Topics: Animals; Brain; Deep Brain Stimulation; History, 20th Century; Humans; Mental Disorders; Nervous System Diseases; Neural Pathways
PubMed: 17015236
DOI: 10.1016/j.neuron.2006.09.022 -
Cleveland Clinic Journal of Medicine Jul 2010Deep brain stimulation has emerged as an experimental treatment option for the sizeable proportion of patients with major depression that is refractory to multiple... (Review)
Review
Deep brain stimulation has emerged as an experimental treatment option for the sizeable proportion of patients with major depression that is refractory to multiple medications and psychotherapy. Chronic stimulation of the ventral internal capsule/ventral striatum has been shown to improve function and mood in patients with severe obsessive-compulsive disorder, and has likewise been applied to patients with treatment-resistant depression. Multicenter experience with chronic deep brain stimulation of the ventral capsule/ventral striatum in 17 patients with severe treatment-resistant depression has demonstrated sustained improvements across multiple scales of depression, anxiety, and global function. Further research on deep brain stimulation in larger populations of patients with treatment-refractory depression is under way. While such research should benefit from the recent US Food and Drug Administration approval of deep brain stimulation for severe obsessive-compulsive disorder, it must adhere to strict principles for appropriate patient selection.
Topics: Basal Ganglia; Chronic Disease; Deep Brain Stimulation; Depressive Disorder; Humans; Obsessive-Compulsive Disorder; Psychosurgery; Treatment Outcome
PubMed: 20622083
DOI: 10.3949/ccjm.77.s3.14 -
Stereotactic and Functional Neurosurgery 2022Serendipity and observations have a noble tradition in medicine, including neurology, and are responsible for many medical treatments (carbamazepine for tic douloureux,... (Review)
Review
BACKGROUND
Serendipity and observations have a noble tradition in medicine, including neurology, and are responsible for many medical treatments (carbamazepine for tic douloureux, amantadine for Parkinson's disease, gabapentin for restless legs…). We aimed at examining the contribution of serendipity and observations to functional neurosurgery. Scholarly publications relevant to the history of functional neurosurgery for movement and psychiatric disorders were reviewed, starting from the pre-stereotactic era. The documents were scrutinized with respect to indications for surgery, surgical methods, and brain targets, in view of determining whether serendipitous discoveries and other observations contributed to various functional neurosurgical procedures.
SUMMARY
James Parkinson's observation that tremors disappeared in the arm of a person with shaking palsy after a hemiparetic stroke encouraged neurosurgeons in the first half of the 20th century to perform ablative procedures on central motor pathways. Following a lobotomy performed by Browder that extended too far medially in a psychiatric patient with coexisting Parkinson's disease (PD), it was noted that the Parkinsonian signs improved. This encouraged Russel Meyers to carry out open surgery on the caudate nucleus and basal ganglia in PD. Cooper introduced ligation of the anterior choroidal artery as a treatment for PD following a surgical accident during a pedunculotomy. Cooper later started to perform stereotactic surgery on the ventrolateral thalamus following the pathological finding that an intended pallidal lesion had in fact targeted the thalamus. Leksell discovered the ideal location of a pallidal lesion being in the posteroventral area empirically, long before the advent of the basal ganglia model of PD. Modern Deep Brain Stimulation (DBS) that started in the thalamus for tremor was the result of an observation by Benabid that intraoperative high-frequency stimulation during a thalamotomy reduced tremor. Both the discoveries of the anterior limbic subthalamic nucleus as a DBS target for OCD and the medial forebrain bundle as a DBS target for depression occurred by chance. Hamani and Lozano observed memory flashbacks in a patient who was undergoing DBS for obesity, which led to the discovery of the fornix as a potential DBS target for Alzheimer's disease.
KEY MESSAGES
In the history of functional neurosurgery, serendipity and observations have resulted in discoveries of several procedures, brain targets for lesioning or DBS as well as new clinical surgical indications. In this era of neuromodulation, this technology should be exquisite in allowing potential serendipitous discoveries, provided that clinicians remain both observant and prepared.
Topics: Deep Brain Stimulation; History, 20th Century; Humans; Neurosurgery; Observation; Parkinson Disease; Psychosurgery; Stroke; Tremor
PubMed: 35882210
DOI: 10.1159/000525794 -
Expert Review of Neurotherapeutics Dec 2009Epilepsy imposes a significant clinical, epidemiologic and economic burden on societies throughout the world. Despite the development of more than ten new antiepileptic... (Review)
Review
Epilepsy imposes a significant clinical, epidemiologic and economic burden on societies throughout the world. Despite the development of more than ten new antiepileptic drugs over the past 15 years, approximately a third of patients with epilepsy remain resistant to pharmacotherapy. Individuals who fail to respond, or respond only partially, continue to have incapacitating seizures. Managing patients with medically refractory epilepsy is challenging and requires a structured multidisciplinary approach in specialized clinics. If the problems related to drug resistance could be resolved, even in part, by improving the pharmacokinetic profile of existing drugs, the economic savings would be remarkable and the time required to design drugs that achieve seizure control would be shorter than the discovery of new targets and molecules was required. A promising approach is the use of corticosteroids that may have a dual beneficial effect. Resective brain surgery remains the ultimate and highly successful approach to multiple drug resistance in epileptic patients.
Topics: Anticonvulsants; Diet, Ketogenic; Drug Resistance, Multiple; Electric Stimulation Therapy; Epilepsy; Humans; Psychosurgery; Secondary Prevention
PubMed: 19951138
DOI: 10.1586/ern.09.114 -
Seizure Jan 2013Lennox-Gastaut syndrome (LGS) is an epileptogenic disorder that arises in childhood and is typically characterized by multiple seizure types, slow spike-and-wave... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Lennox-Gastaut syndrome (LGS) is an epileptogenic disorder that arises in childhood and is typically characterized by multiple seizure types, slow spike-and-wave complexes on EEG and cognitive impairment. If medical treatment fails, patients can proceed to one of two palliative surgeries, vagus nerve stimulation (VNS) or corpus callosotomy (CC). Their relative seizure control rates in LGS have not been well studied. The purpose of this paper is to compare seizure reduction rates between VNS and CC in LGS using meta-analyses of published data.
METHODS
A systematic search of Pubmed, Ovidsp, and Cochrane was performed to find articles that met the following criteria: (1) prospective or retrospective study, (2) at least one patient diagnosed with Lennox-Gastaut syndrome, and (3) well-defined measure of seizure frequency reduction. Seizure reduction rates were divided into seizure subtypes, as well as total seizures, and categorized as 100%, >75%, and >50%. Patient groups were compared using chi-square tests for categorical variables and t-test for continuous measures. Pooled proportions with 95% confidence interval (95% CI) of seizure outcomes were estimated for total seizures and seizure subtypes using random effects methods.
RESULTS
17 VNS and 9 CC studies met the criteria for inclusion. CC had a significantly better outcome than VNS for >50% atonic seizure reduction (80.0% [67.0-90.0%] vs. 54.1% [32.1-75.4%], p<0.05) and for >75% atonic seizure reduction (70.0% [48.05-87.0%] vs. 26.3% [5.8-54.7%], p<0.05). All other seizure types, as well as total number of seizures, showed no statistically significant difference between VNS and CC.
CONCLUSIONS
CC may be more beneficial for LGS patients whose predominant disabling seizure type is atonic. For all other seizure types, VNS offers comparable rates to CC.
Topics: Corpus Callosum; Humans; Intellectual Disability; Lennox Gastaut Syndrome; Neurosurgery; Psychosurgery; Spasms, Infantile; Vagus Nerve Stimulation
PubMed: 23068970
DOI: 10.1016/j.seizure.2012.09.014 -
Tidsskrift For Den Norske Laegeforening... Feb 2007Epilepsy is a common term for different syndromes and diseases, which are all characterized by repeated unprovoked epileptic seizures. Large variations in seizure types,... (Review)
Review
BACKGROUND
Epilepsy is a common term for different syndromes and diseases, which are all characterized by repeated unprovoked epileptic seizures. Large variations in seizure types, severity and presence of co-morbidity necessitate very diverse rehabilitation efforts.
MATERIAL AND METHODS
Based on a literature review and the authors' own clinical experience, the rehabilitation approach to epilepsy is discussed.
RESULTS AND INTERPRETATION
Epilepsy is a complex medical disorder and the rehabilitation process must address many aspects. Although 2/3 of patients achieve a satisfactory seizure control with current antiepileptic drugs, they may still have considerable epilepsy-related problems, such as drug-related side effects or psychosocial difficulties. The remaining 1/3 who continue to have seizures, need regular specialist follow-up, as well as multidisciplinary evaluations to ensure comprehensive, individually tailored rehabilitation programmes. The aim of the rehabilitation is to eliminate or reduce the medical and social consequences of the disease. Counselling and education of patients are important elements. In Norway, the importance of providing adequate medical information has now been acknowledged through legislation. The rehabilitation needs for people with epilepsy are far from covered. A controlled study has recently demonstrated a significant effect of a nurse-led intervention programme on quality of life parameters in patients with uncontrolled epilepsy. We recommend specially assigned epilepsy nurses in all departments treating individuals with epilepsy.
Topics: Anticonvulsants; Counseling; Epilepsy; Follow-Up Studies; Humans; Patient Care Planning; Patient Care Team; Patient Education as Topic; Psychosurgery; Quality of Life; Rehabilitation Centers; Social Support; Socioeconomic Factors
PubMed: 17279111
DOI: No ID Found