The metabolic effects of limbic leucotomy in Gilles de la Tourette syndrome.

Sawle, G. V.; Lees, Andrew J.; Hymas, Nigel; Brooks, David J.; Frackowiak, R. S. J.

doi:10.1136/jnnp.56.9.1016

Cited by 32 publications

(23 citation statements)

References 21 publications

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“…Hence, this multi-site operation would presumably combine the benefits (as well as potential adverse effects) of those two procedures. A single case study of limbic leucotomy has demonstrated reduced activity within the caudate nuclei in a patient with OCD and Tourette Syndrome (TS), when comparing postsurgical to presurgical regional cerebral oxygen metabolism (Sawle et al, 1993). Both OCD and TS symptoms improved in this patient after limbic leucotomy.…”

Section: Neurocircuitry Of Ocd and Surgical Targetsmentioning

confidence: 85%

Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

Greenberg

Rauch

Haber

2009

Neuropsychopharmacol

325

229

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Psychiatric neurosurgery, specifically stereotactic ablation, has continued since the 1940s, mainly at a few centers in Europe and the US. Since the late 1990s, the resurgence of interest in this field has been remarkable; reports of both lesion procedures and the newer technique of deep brain stimulation (DBS) have increased rapidly. In early 2009, the US FDA granted limited humanitarian approval for DBS for otherwise intractable obsessive-compulsive disorder (OCD), the first such approval for a psychiatric illness. Several factors explain the emergence of DBS and continued small-scale use of refined lesion procedures. DBS and stereotactic ablation have been successful and widely used for movement disorders. There remains an unmet clinical need: current drug and behavioral treatments offer limited benefit to some seriously ill people. Understandings of the neurocircuitry underlying psychopathology and the response to treatment, while still works in progress, are much enhanced. Here, we review modern lesion procedures and DBS for OCD in the context of neurocircuitry. A key issue is that clinical benefit can be obtained after surgeries targeting different brain structures. This fits well with anatomical models, in which circuits connecting orbitofrontal cortex (OFC), medial prefrontal cortex (mPFC), basal ganglia, and thalamus are central to OCD pathophysiology and treatment response. As in movement disorders, dedicated interdisciplinary teams, here led by psychiatrists, are required to implement these procedures and maintain care for patients so treated. Available data, although limited, support the promise of stereotactic ablation or DBS in carefully selected patients. Benefit in such cases appears not to be confined to obsessions and compulsions, but includes changes in affective state. Caution is imperative, and key issues in long-term management of psychiatric neurosurgery patients deserve focused attention. DBS and contemporary ablation also present different patterns of potential benefits and burdens. Translational research to elucidate how targeting specific nodes in putative OCD circuitry might lead to therapeutic gains is accelerating in tandem with clinical use.

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Section: Neurocircuitry Of Ocd and Surgical Targetsmentioning

confidence: 85%

Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

Greenberg

Rauch

Haber

2009

Neuropsychopharmacol

325

229

View full text Add to dashboard Cite

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“…Frontal lobe operations have included prefrontal lobotomies 37,42 and bimedial frontal leukotomies. 5,27 The limbic system was targeted during limbic leukotomy 32,34 and cingulotomy 4,20,21 with or without hypothalamotomy. Thalamic operations have included lesions of the medial, intralaminar, and ventrolateral thalamic nuclei.…”

Section: Discussionmentioning

confidence: 99%

Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome

Visser‐Vandewalle

Temel²,

Boon³

et al. 2003

Journal of Neurosurgery

253

185

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Based on the results of thalamotomies described by Hassler in 1970, the authors performed bilateral thalamic high-frequency stimulation (HFS) in three patients with intractable Tourette syndrome (TS). In this report they describe the long-term effects. Three male patients (42, 28, and 45 years of age) had manifested motor and vocal tics since early childhood. The diagnosis of TS was made according to the criteria of the Tourette Syndrome Classification Study Group. Any drug or alternative treatment had been either ineffective or only temporarily effective in all three patients. There was no serious comorbidity. The target for stimulation was chosen at the level of the centromedian nucleus, substantia periventricularis, and nucleus ventrooralis internus. After 2 weeks of test stimulation, the pulse generators were implanted. After a follow-up period of 5 years in the patient in Case 1, 1 year in the patient in Case 2, and 8 months in the patient in Case 3, all major motor and vocal tics had disappeared and no serious complications had occurred. When stimulation was applied at the voltage necessary to achieve an optimal result on the tics, a slight sedative effect was noted in all three patients. In the patients in Cases 1 and 3 there were stimulation-induced changes in sexual behavior. Chronic thalamic HFS may be an effective and safe treatment for medically intractable TS in adult patients. Unwanted stimulation-induced side effects may occur.

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“…PET and SPECT studies also identified frontal lobe metabolic differences between TS and normal subjects [5,6,9,10,12,15,32,40,45,47,51]. With a statistical model Eidelberg et al [12] identified two brain networks related to the symptoms of TS.…”

Section: S Sensory Function and Sensorimotor Integrationmentioning

confidence: 94%

Pathophysiology of tics and Tourette syndrome

Berardelli

Currà

Fabbrini

et al. 2003

Journal of Neurology

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Tics are involuntary movements that can affect one or more muscles producing simple or complex movements. Blink reflex and startle reflex studies disclose an increased excitability of brainstem interneurons. Analysis of voluntary movement shows that when advance visual information is reduced, patients with tics and Tourette syndrome become progressively slower in completing motor sequences. Sensorimotor integration is abnormally processed. Studies of the contingent negative variation demonstrate abnormalities of movement preparation and the investigation of premotor potentials shows that in some patients tics are not preceded by a normal premotor potential. Magnetic stimulation studies demonstrate an increased excitability of cortical motor cortex. Functional MRI, PET and SPECT studies show abnormal activation of cortical and subcortical areas. Dysfunction of basal ganglia-thalamo-cortical projections affects sensorimotor, language and limbic cortical circuits, and may explain why patients with Tourette syndrome have difficulty in inhibiting unwanted behaviors and impulses.

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The metabolic effects of limbic leucotomy in Gilles de la Tourette syndrome.

Cited by 32 publications

References 21 publications

Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome

Pathophysiology of tics and Tourette syndrome

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