A new lesion for the psychosurgical operation of stereotactic subcaudate tractotomy (SST)
ABSTRACT The psychosurgical treatment of psychiatric illnesses, using stereotactic subcaudate tractotomy (SST), has been carried out at the Geoffrey Knight Unit since 1961. Recently, the procedure has had to be modified. This paper describes the manner in which this has been achieved and the clinical implications of this change.
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ABSTRACT: Background Deep brain stimulation (DBS) applied to the subgenual cingulate cortex (SCC) has been recently investigated as a potential treatment for severe and chronic treatment-resistant depression (TRD). Given its invasive and experimental nature, a comprehensive evaluation of its effectiveness and acceptability is of paramount importance. Therefore, we conducted the present systematic review and exploratory meta-analysis. Methods We searched the literature for English language prospective clinical trials on DBS of the SCC for TRD from 1999 through December 2012 using MEDLINE, EMBASE, PsycINFO, CENTRAL and SCOPUS, and performed a random effects exploratory meta-analysis using Event Rates and Hedges׳ g effect sizes. Results Data from 4 observational studies were included, totaling 66 subjects with severe and chronic TRD. Twelve-month response and remission rates following DBS treatment were 39.9% (95% CI=28.4% to 52.8%) and 26.3% (95% CI=13% to 45.9%), respectively. Also, depression scores at 12 months post-DBS were significantly reduced (i.e., pooled Hedges׳ g effect size=−1.89 [95% CI=−2.64 to −1.15, p<0.0001]). Also, there was a significant decrease in depression scores between 3 and 6 months (Hedges׳ g=−0.27, p=0.003), but no significant changes from months 6 to 12. Finally, dropout rates at 12 months were 10.8% (95% CI=4.3% to 24.4%). Limitations Small number of included studies (most of which were open label), and limited long-term effectiveness data. Conclusions DBS applied to the SCC seems to be associated with relatively large response and remission rates in the short- and medium- to long-term in patients with severe TRD. Also, its maximal antidepressant effects are mostly observed within the first 6 months after device implantation. Nevertheless, these findings are clearly preliminary and future controlled trials should include larger and more representative samples, and focus on the identification of optimal neuroanatomical sites and stimulation parameters.Journal of Affective Disorders 04/2014; 159:31–38. DOI:10.1016/j.jad.2014.02.016 · 3.71 Impact Factor
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ABSTRACT: Despite the application of ablative neurosurgical treatments for intractable mental disorder throughout most of the past century, unequivocal evidence for efficacy has not been provided. To review the status of ablative neurosurgery for mental disorder and to describe the activities of the Scottish national service. Relevant literature is reviewed alongside a description of recent clinical activity. Neurosurgical treatment is offered to a small number of patients severely disabled by otherwise intractable mental disorder. There are inequalities in the strength of evidence to support the use of some of these procedures. The frequency and severity of adverse effects remains unclear. We are collecting data that should inform future practice. Modern neurosurgery can offer clinically meaningful symptom relief and improved function for 'untreatable' patients with chronic, severe depression and obsessive-compulsive disorder. However, follow-up studies of greater rigour are required. The potential role of non-ablative alternatives remains unclear.The British Journal of Psychiatry 06/2003; 182:404-11. DOI:10.1192/bjp.182.5.404 · 7.34 Impact Factor
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ABSTRACT: To briefly describe the novel non-drug physical interventions currently in use in the investigation and treatment of neuropsychiatric disorders regarding their efficacy and potential future applications. A systematic review of the literature concerning transcranial magnetic stimulation (TMS), deep brain stimulation (DBS), vagus nerve stimulation (VNS) and neurosurgery for mental disorders (NMD) was conducted using Medline and literature known to the authors. A summary of each procedure is provided giving a succinct overview of efficacy, current applications and possible future indications. Novel and innovative physical interventions are currently being used to study brain function in health and disease. In particular, TMS has quickly established itself as a useful investigational tool and is emerging as a possible antidepressant therapy. Similarly, VNS has been applied successfully in the management of intractable epilepsy and is undergoing evaluation in the management of patients with treatment-resistant depression. DBS has shown significant promise in the treatment of Parkinson's disease and may have use in the management of obsessive-compulsive disorder. Finally, neurosurgical procedures for the treatment of mental disorders have been sufficiently refined to stage a comeback, although rigorous scientific study of their efficacy and indications is still necessary.Journal of Psychosomatic Research 09/2002; 53(2):709-19. DOI:10.1016/S0022-3999(02)00423-3 · 2.84 Impact Factor