Review of Long-term Results of Stereotactic Psychosurgery.

Abstract

Stereotactic psychosurgery is an effective method for treating some medically intractable psychiatric illnesses. However, it is unfamiliar and the long-term clinical results have not been reported in Asia. The long-term results of psychosurgery are evaluated and the neuroanatomical basis is discussed. Twenty-one patients underwent stereotactic psychosurgery for medically intractable psychiatric illnesses since 1993. All were referred from psychiatrists for these disorders. Two patients showed aggressive behavior, 12 had obsessive-compulsive disorder (OCD), and seven had depression with anxiety disorders. Bilateral amygdalotomy and subcaudate tractotomy were performed for aggressive behavior, limbic leucotomy was performed for OCD, and subcaudate tractotomy with or without cingulotomy was performed for depression with anxiety. OCD was evaluated with the Yale-Brown Obsessive Compulsive Scale (YBOCS), the visual analogue scale, the Clinical Global Impression Scale, and the Overt Aggression Scale (OAS). The Mini-Mental State Examination and the Wechsler Adult Intelligence ScaleRevised were used for the evaluation of aggressive behavior. The 17-item Hamilton Depression Rating Scale (HAMD) was used for evaluation of depression. Ventriculography was used in the first seven patients and magnetic resonance imaging-guided stereotaxy was used in the recent 14 cases for localization of the target. The lesions were made with a radiofrequency lesion generator. OAS scores in the two patients with aggressive behavior during follow up declined from 8 to 2 with clinical improvement. All 12 patients with OCD returned to their previous life and showed the mean YBOCS scores decreased from 34 to 3. Ten patients with OCD could be followed up (mean 45 months). All patients returned to their previous social life. In seven patients with depression with anxiety, HAMD scores declined from 28.5 to 16.5. There was no operative mortality and no significant morbidity except for one case of mild transient urinary incontinence. These long-term results indicate that stereotactic psychosurgery is a safe and effective method of treating some medically intractable psychiatric illnesses.

Deep brain stimulation for psychiatric disorders: where we are now

“…134,287 Bilateral DBS of the ITP was first demonstrated in 2005 in a case study of a woman with severe, treatment-refractory MDD comorbid with borderline personality disorder and bulimia. 119 The patient had a baseline HDRS score of 33, and after starting stimulation this score dropped, corresponding to a rise in her GAF from 20 to 90.…”

Deep brain stimulation of the orbitofrontal projections for the treatment of intermittent explosive disorder

“…They felt, however, that with modern stereotactic surgical techniques, the procedure should still be considered for patients with severe aggressive disorders refractory to current therapies. In 2002, Kim et al 18 reported long-term follow-up of 2 patients with aggressive disorders in whom they performed bilateral amygdalotomy and subcaudate tractotomy. A stereotactic approach and a radiofrequency lesion generator were used to target these regions.…”

“…13 The authors found a decline in aggression at 2-weeks and at 7-year follow-up visits with improvement in social behavior. 18 Deep brain stimulation of the hypothalamus has also been described as a means of controlling intractable aggressive disorders. 10,14,20 Hernando and colleagues 14 described one such case of a young man with mental retardation and intractable aggressive disorder in whom bilateral electrodes were implanted in the medial posterior hypothalamus.…”

Stereotactic lesions for the treatment of psychiatric disorders

“…Table 2 summarizes the procedural distribution for each disorder. [5][6][7][8][11][12][13][14][15]18,[21][22][23]25,26,28,29,[31][32][33]35,36,43,44,47,50,[52][53][54] Either the Mann-Whitney U-test or Kruskal-Wallis test was performed on each of these 7 disorder groups to determine if there was a statistically significant difference in the outcomes from the different anatomical targets.…”