Modern neurosurgical techniques for psychiatric disorders

Salles, Antônio De; Lucena, Luan; Paranhos, Thiago; Ferragut, Maria Alice; Oliveira‐Souza, Ricardo de; Gorgulho, Alessandra

doi:10.1016/bs.pbr.2022.01.025

Cited by 2 publications

(4 citation statements)

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“…Mental health conditions amenable to ablative psychosurgery primarily include disorders with documented involvement of the cortico-striato-thalamo-cortical pathways such as obsessive-compulsive disorders (OCD), Tourette syndrome (TS) and major depressive disorders (MDD). 15,16 Nowadays these procedures are carried out by a few specialized neuroscience centres.…”

Section: Current Neurosurgical Techniques To Treat Mental Health Cond...mentioning

confidence: 99%

“…[8][9][10] The decline of psychosurgery was associated with the emergence of effective treatments such as antipsychotics and was also due to the limited evidence for their use (based on small-scale longitudinal studies), the lack of randomized controlled trials, the absence of clear diagnostic indications for its use, risky procedures, adverse effects, and ethical violations involved in its implementation. 15 Here we provide an overview of the current state of neurosurgery for the treatment of psychiatric disorders, discuss some of the most relevant past and present ethical considerations whilst providing clinical examples, and offer a view of what the future of psychosurgery is likely to entail. Above all, clinicians must remain aware that there are always risks that may limit the application of neurosurgery in mental health, for example, anesthesia, infection, convulsions, etc.…”

Section: Introductionmentioning

confidence: 99%

“…The decline of psychosurgery was associated with the emergence of effective treatments such as antipsychotics and was also due to the limited evidence for their use (based on small-scale longitudinal studies), the lack of randomized controlled trials, the absence of clear diagnostic indications for its use, risky procedures, adverse effects, and ethical violations involved in its implementation. 15…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

et al. 2023

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The anniversary of the publication of 'One Flew Over the Cuckoo's Nest' by Ken Kesey offers an opportunity for reflection on the use of neurosurgery in psychiatry. We used a narrative, historical and dialectical method to deliver an account of the controversial subject. A balanced representation of the negative and positive aspects, acknowledging some of the questionable ethical practices while describing well-reasoned applications is provided. It includes neurosurgeons, psychiatrists who have embraced these procedures with unwarranted enthusiasm and those who have opposed. Neurosurgical techniques for the treatment of severe mental disorders have evolved from rudimentary procedures which were used to ‘correct' unwanted behaviours associated with a wide range of severe mental disorders to more refined and selective approaches used as a last resort to treat specific mental health conditions. In the absence of specific aetiological models to guide ablative surgical targets, non-ablative, stimulatory techniques have more recently been developed to allow reversibility when surgical treatment fails to obtain a sizeable improvement in quality of life. The subject is concretely illustrated by two eloquent clinical images: one on a series of brain computed tomography scans carried out on a Canadian population of subjects, who underwent leukotomy decades ago, and the other more contemporary on an implantation surgery to epidural stimulation. Alongside technical advances in psychosurgery, a regulatory framework has gradually developed to ensure vigilance in the appropriateness of patients’ selection. Nevertheless, harmonisation of protocols around the world is necessary to ensure consistency in obtaining and maintaining the highest possible ethical standards for the benefit of patients. If the neurosciences promise today, in their new, better framed, and reversible applications, to provide answers to unmet therapeutic needs, we still must remain attentive to drifts linked the introduction of intrusive technologies for purposes of domination or behaviour modification that would impede our individual freedom.

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Section: Current Neurosurgical Techniques To Treat Mental Health Cond...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

et al. 2023

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“…Deep brain stimulation (DBS) has received full Food and Drug Administration approval for essential tremor and Parkinson’s disease and an Humanitarian Device Exemption approval for dystonia and obsessive compulsive disorder. DBS research has recently been expanding to include other neuropsychiatric indications 1 – 5 . Approved indications, with the exception of epilepsy, have focused on the continuous delivery of electrical stimulation.…”

Section: Introductionmentioning

confidence: 99%

Responsive deep brain stimulation for the treatment of Tourette syndrome

Okun,

Cagle,

Gomez

et al. 2024

Sci Rep

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To report the results of ‘responsive’ deep brain stimulation (DBS) for Tourette syndrome (TS) in a National Institutes of Health funded experimental cohort. The use of ‘brain derived physiology’ as a method to trigger DBS devices to deliver trains of electrical stimulation is a proposed approach to address the paroxysmal motor and vocal tic symptoms which appear as part of TS. Ten subjects underwent bilateral staged DBS surgery and each was implanted with bilateral centromedian thalamic (CM) region DBS leads and bilateral M1 region cortical strips. A series of identical experiments and data collections were conducted on three groups of consecutively recruited subjects. Group 1 (n = 2) underwent acute responsive DBS using deep and superficial leads. Group 2 (n = 4) underwent chronic responsive DBS using deep and superficial leads. Group 3 (n = 4) underwent responsive DBS using only the deep leads. The primary outcome measure for each of the 8 subjects with chronic responsive DBS was calculated as the pre-operative baseline Yale Global Tic Severity Scale (YGTSS) motor subscore compared to the 6 month embedded responsive DBS setting. A responder for the study was defined as any subject manifesting a ≥ 30 points improvement on the YGTSS motor subscale. The videotaped Modified Rush Tic Rating Scale (MRVTRS) was a secondary outcome. Outcomes were collected at 6 months across three different device states: no stimulation, conventional open-loop stimulation, and embedded responsive stimulation. The experience programming each of the groups and the methods applied for programming were captured. There were 10 medication refractory TS subjects enrolled in the study (5 male and 5 female) and 4/8 (50%) in the chronic responsive eligible cohort met the primary outcome manifesting a reduction of the YGTSS motor scale of ≥ 30% when on responsive DBS settings. Proof of concept for the use of responsive stimulation was observed in all three groups (acute responsive, cortically triggered and deep DBS leads only). The responsive approach was safe and well tolerated. TS power spectral changes associated with tics occurred consistently in the low frequency 2–10 Hz delta-theta-low alpha oscillation range. The study highlighted the variety of programming strategies which were employed to achieve responsive DBS and those used to overcome stimulation induced artifacts. Proof of concept was also established for a single DBS lead triggering bi-hemispheric delivery of therapeutic stimulation. Responsive DBS was applied to treat TS related motor and vocal tics through the application of three different experimental paradigms. The approach was safe and effective in a subset of individuals. The use of different devices in this study was not aimed at making between device comparisons, but rather, the study was adapted to the current state of the art in technology. Overall, four of the chronic responsive eligible subjects met the primary outcome variable for clinical effectiveness. Cortical physiology was used to trigger responsive DBS when therapy was limited by stimulation induced artifacts.

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Modern neurosurgical techniques for psychiatric disorders

Cited by 2 publications

References 122 publications

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

Responsive deep brain stimulation for the treatment of Tourette syndrome

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