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Postgraduate Medical Journal Sep 1968
Review
Topics: Adrenocorticotropic Hormone; Anemia; Anti-Bacterial Agents; Colitis, Ulcerative; Cortisone; Diet Therapy; Enterocolitis, Pseudomembranous; Humans; Hypothermia, Induced; Immunosuppressive Agents; Iron; Psychosurgery; Psychotherapy; Rest; Water-Electrolyte Balance
PubMed: 4303135
DOI: 10.1136/pgmj.44.515.696 -
Stereotactic and Functional Neurosurgery 2022Ablative lesion procedures remain as the last option in treatment of refractory depression. Contemporary ablative psychosurgeries involve producing lesions in the... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND OBJECTIVES
Ablative lesion procedures remain as the last option in treatment of refractory depression. Contemporary ablative psychosurgeries involve producing lesions in the anterior limb of the internal capsule (bilateral anterior capsulotomy - BAC), the supragenual anterior cingulate gyrus and cingulum (bilateral anterior cingulotomy - BACING), and subgenual anterior cingulate gyrus and subcortical orbitofrontal white matter (bilateral subcaudate tractotomy - BST). A combination of BACING and BST is known as limbic leukotomy (bilateral limbic leukotomy - BLL). All procedures claim some success, but cohorts are small, depression assessment instruments differ, and inclusion and outcome criteria and follow-up duration vary. In some cohorts, more than one type of surgery was performed in several patients, further confounding interpreting the available data. Current evidence is equivocal on which surgical target works best. Method and Aim: This systematic review and meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) standard on published cohorts was conducted to review and identify which is the best standalone ablative procedure for treatment-resistant depression (TRD) based on response rate (event rate) and adverse-effect profile using the Comprehensive Meta-Analysis software.
RESULTS AND CONCLUSION
As a standalone neurosurgical procedure, we found that BAC appears to be the most effective and safest of all the ablative targets for TRD. A major limitation of this conclusion is the paucity of published case series where sample sizes are small and all are open label.
Topics: Humans; Depression; Depressive Disorder, Treatment-Resistant; Psychosurgery; Neurosurgical Procedures; Gyrus Cinguli
PubMed: 35973404
DOI: 10.1159/000526000 -
Epilepsy & Behavior : E&B Oct 2015Atonic seizures are debilitating and poorly controlled with antiepileptic medications. Two surgical options are primarily used to treat medically refractory atonic... (Review)
Review
Atonic seizures are debilitating and poorly controlled with antiepileptic medications. Two surgical options are primarily used to treat medically refractory atonic seizures: corpus callosotomy (CC) and vagus nerve stimulation (VNS). However, given the uncertainty regarding relative efficacy and surgical complications, the best approach for affected patients is unclear. The PubMed database was queried for all articles describing the treatment of atonic seizures and drop attacks with either corpus callosotomy or VNS. Rates of seizure freedom, >50% reduction in seizure frequency, and complications were compared across the two patient groups. Patients were significantly more likely to achieve a >50% reduction in seizure frequency with CC versus VNS (85.6% versus 57.6%; RR: 1.5; 95% CI: 1.1-2.1). Adverse events were more common with VNS, though typically mild (e.g., 22% hoarseness and voice changes), compared with CC, where the most common complication was the disconnection syndrome (13.2%). Both CC and VNS are well tolerated for the treatment of refractory atonic seizures. Existing studies suggest that CC is potentially more effective than VNS in reducing seizure frequency, though a direct study comparing these techniques is required before a definitive conclusion can be reached.
Topics: Corpus Callosum; Epilepsy, Generalized; Humans; Psychosurgery; Syncope; Vagus Nerve Stimulation
PubMed: 26247311
DOI: 10.1016/j.yebeh.2015.06.001 -
Epilepsia Sep 2009Epilepsy that originates outside of the temporal lobe can present some of the most challenging problems for surgical therapy. These epilepsies can be broadly categorized... (Review)
Review
Epilepsy that originates outside of the temporal lobe can present some of the most challenging problems for surgical therapy. These epilepsies can be broadly categorized as lesional or non-lesional, with the nonlesional cases being the most difficult to localize. Lesional cases can result from malformations of cortical development, tumors, vascular malformations, or areas of old injury. Some lesions, such as focal cortical dysplasia, can be challenging, in that the boundaries of the pathology can be difficult to define. Presurgical goals include defining the structural lesion, the physiologic abnormality, and normal function in the area. These goals can be achieved using a variety of noninvasive and invasive tests. Surgical techniques vary depending on location and pathology but they always include removal of the epileptic brain tissue while preserving en passage vessels and underlying white matter tracts. Surgical outcomes vary depending on the underlying pathology. Surgeries are usually planned with a goal of no expected postoperative deficits, although temporary deficits may be anticipated in some areas, such as the supplementary motor cortex. Extratemporal epilepsy can be managed well with surgical treatment; but proper patient selection, evaluation, and discussion of expected outcomes and risks are critical in this challenging patient population.
Topics: Adult; Brain; Cerebral Cortex; Diagnostic Imaging; Electrodes, Implanted; Epilepsies, Partial; Epilepsy; Humans; Male; Motor Cortex; Neocortex; Neurosurgical Procedures; Preoperative Care; Psychosurgery; Treatment Outcome
PubMed: 19702737
DOI: 10.1111/j.1528-1167.2009.02239.x -
Tidsskrift For Den Norske Laegeforening... Dec 2022
Topics: Humans; History, 20th Century; Psychosurgery; Mental Disorders; Learning
PubMed: 36511739
DOI: 10.4045/tidsskr.22.0505 -
Brain Sciences Dec 2021Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized...
Deep brain stimulation (DBS) requires a precise localization, which is especially difficult at the hypothalamus, because it is usually performed in anesthetized patients. We aimed to characterize the neurophysiological properties posteromedial hypothalamus (PMH), identified by the best neurophysiological response to electrical stimulation. We obtained microelectrode recordings from four patients with intractable aggressivity operated under general anesthesia. We pooled data from 1.5 mm at PMH, 1.5 mm upper (uPMH) and 1.5 mm lower (lPMH). We analyzed 178 units, characterized by the mean action potential (mAP). Only 11% were negative. We identified the next types of units: P1N1 (30.9%), N1P1N2 (29.8%), P1P2N1 (16.3%), N1P1 and N1N2P1 (6.2%) and P1N1P2 (5.0%). Besides, atypical action potentials (amAP) were recorded in 11.8%. PMH was highly different in cell composition from uPMH and lPMH, exhibiting also a higher percentage of amAP. Different kinds of cells shared similar features for the three hypothalamic regions. Although features for discharge pattern did not show region specificity, the probability mass function of inter-spike interval were different for all the three regions. Comparison of the same kind of mAP with thalamic neurons previously published demonstrate that most of cells are different for derivatives, amplitude and/or duration of repolarization and depolarization phases and also for the first phase, demonstrating a highly specificity for both brain centers. Therefore, the different properties described for PMH can be used to positively refine targeting, even under general anesthesia. Besides, we describe by first time the presence of atypical extracellular action potentials.
PubMed: 35053786
DOI: 10.3390/brainsci12010043 -
California Medicine Jun 1958Although the advent and widespread use of ataractic drugs has more or less eclipsed lobotomy as a method of dealing with severe psychotic states, variations and...
Although the advent and widespread use of ataractic drugs has more or less eclipsed lobotomy as a method of dealing with severe psychotic states, variations and adaptations of the operation still can be used with benefit in certain pretty well defined circumstances."Chemical lobotomy" and regressive electroshock bring about alterations in behavior superficially resembling those of lobotomy, but without the changes in personality that are the object of lobotomy. These desirable changes consist in increased extraversion, decreased preoccupation with self and decreased sensitivity to the opinions of others. With restricted operations, undesirable changes-the "frontal lobe syndrome"-do not occur. OPERATIVE FAILURES ARE DUE TO THREE MAIN CAUSES: (a) Preoperative emotional deterioration; (b) progress of the underlying disease; (c) relapse, possibly due to inadequate operation. Lobotomy is advisable if the patient does not show sustained improvement after a year of active treatment by other indicated means. The operation often represents the turning point in effective treatment. After the first year of ineffective treatment valuable time is being lost, with danger of fixation and deterioration. Then it is safer to operate than to wait. The future of psychosurgery lies in prompt application, in favorable patients, of selective operations that will reverse the trend of illness. There is particular need for further exploration of the temporal lobes in the hope of finding some procedure that will suppress hallucinations. Some 90 per cent of patients remaining in hospitals after psychosurgery are experiencing hallucinations. If these phenomena can be eliminated without producing serious personality defects, another large field for the application of psychosurgery will be opened.
Topics: Hallucinations; Humans; Mental Disorders; Psychosurgery; Psychotic Disorders; Temporal Lobe
PubMed: 13536859
DOI: No ID Found -
Revista Brasileira de Psiquiatria (Sao... Mar 2004
Topics: Human Experimentation; Humans; Informed Consent; Psychosurgery
PubMed: 15057832
DOI: 10.1590/s1516-44462004000100004 -
Epilepsia 2001
Review
Topics: Anticonvulsants; Cognition Disorders; Combined Modality Therapy; Drug Interactions; Electric Stimulation Therapy; Epilepsy; Humans; Mental Disorders; Psychosurgery; Risk Factors
PubMed: 11902326
DOI: No ID Found -
Surgical Neurology International 2013In the final installment to this three-part, essay-editorial on psychosurgery, we relate the history of deep brain stimulation (DBS) in humans and glimpse the phenomenal...
Violence, mental illness, and the brain - A brief history of psychosurgery: Part 3 - From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans.
In the final installment to this three-part, essay-editorial on psychosurgery, we relate the history of deep brain stimulation (DBS) in humans and glimpse the phenomenal body of work conducted by Dr. Jose Delgado at Yale University from the 1950s to the 1970s. The inception of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1974-1978) is briefly discussed as it pertains to the "determination of the Secretary of Health, Education and Welfare regarding the recommendations and guidelines on psychosurgery." The controversial work - namely recording of brain activity, DBS, and amygdalotomy for intractable psychomotor seizures in patients with uncontrolled violence - conducted by Drs. Vernon H. Mark and Frank Ervin is recounted. This final chapter recapitulates advances in neuroscience and neuroradiology in the evaluation of violent individuals and ends with a brief discussion of the problem of uncontrolled rage and "pathologic aggression" in today's modern society - as violence persists, and in response, we move toward authoritarianism, with less freedom and even less dignity.
PubMed: 23956934
DOI: 10.4103/2152-7806.115162