Long-Term Outcome of Neurosurgery for the Treatment of Resistant Depression

ArticleinJournal of Neuropsychiatry 17(4):478-85 · February 2005with21 Reads
DOI: 10.1176/appi.neuropsych.17.4.478 · Source: PubMed
Abstract
Between 1973 and 1995, a total of 76 patients were treated with bilateral stereotactic, orbitomedial lesions for resistant severe depression at the Neuropsychiatric Institute, Sydney, Australia. On follow up after a mean 14.4 years, 24 (31.6%) subjects were confirmed dead, with six having committed suicide. Of the 52 patients still alive (mean age 62.9 years), 23 were interviewed in detail, and lesions verified in 18 with magnetic resonance imaging (MRI). On a 6-point global outcome rating scale, rated by consensus between two independent psychiatrists, five (22.7%) were judged to be completely recovered and another 11 (50%) showed significant improvement. The improvement was noted within days or weeks of the surgery. Adverse effects were epilepsy (2 subjects), marked personality change (1), weight gain (2), and mild personality change (5). Any reported cognitive impairment was mild. No definite predictors of improvement were identified.
    • "Of these patients, 5 were reported to be in remission and 11 showed significant improvements in depressive symptomatology. Complications of psychosurgery are profound and include epilepsy, irreversible personality changes and cognitive impairment (Sachdev and Sachdev, 2005; Moreines et al., 2011). "
    Full-text · Dataset · Oct 2014 · Journal of Affective Disorders
    • "[124,149] Los efectos adversos de esta técnica combinada incluyen: cefalea, síndrome confusional transitorio, crisis comiciales, incontinencia urinaria, letargia, perseveración, aumento de peso, suicidio, alteraciones en la memoria y en la personalidad. [7,26,69,80,113,131] "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Surgery for behavioral disorders (SBD) is becoming a more common treatment since the development of neuromodulation techniques. Methods: This article is a non-systematic review of the history, current indications, techniques and surgical targets of SBD. We divide its history into 3 eras: the first era starts in the beginning of psychosurgery and finishes with the development of stereotactic techniques, when the second one starts. It is characterized by the realization of stereotactic lesions. We are traveling through the third era, which begins when deep brain stimulation (DBS) starts to be used for SBD. Results: In spite of the serious mistakes committed in the past, nowadays, SBD is reawakening. The psychiatric disorders which are most frequently treated by surgery are: treatment-resistant depression, obsessive-compulsive disorder and Tourette syndrome. Furthermore, some patients with abnormal aggression were surgically treated. There are several stereotactic targets described for these disorders. Vagus nerve stimulation may be also used for depression. Conclusion: The results of DBS in these disorders seem to be encouraging. However, more randomized trials are needed in order to establish the effectiveness of SBD. It must be taken in mind that a proper patient selection will help us to perform a safer procedure as well as to achieve better surgical results, leading SBD to be more accepted by psychiatrists, patients and their families. Further research is needed in several topics such as: physiopathology of behavioral disorders, indications of SBD and new surgical targets.
    Full-text · Article · Aug 2014
    • "" Psychosurgery " has a long history, and there have been numerous ablative techniques with demonstrated efficacy in TRD. The ability of surgical lesions of the anterior limb of the internal capsule to alleviate depressive symptoms has been well documented (Christmas et al., 2011; Hurwitz et al., 2012; Meyerson and Mindus, 1988), as have subcaudate tractotomies (Malhi and Bartlett, 1998), cingulotomies (Shields et al., 2008), and orbitomedial leucotomies (Sachdev and Sachdev, 2005). The successful replacement of ablative neurosurgical procedures in movement disorder patients by deep brain stimulation (DBS) has laid the foundation for such a transition in psychiatric neurosurgery. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2014
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