medigraphic.com
ISSN 0185-3325 (Print)
Órgano Oficial del Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz

2006, Number 1

<< Back Next >>

Salud Mental 2006; 29 (1)

Introduction to psychiatry neurosurgery

Jiménez PF, Soto AJ, Velasco CF, Castro FG, Carrillo RJD

Language: Spanish
References: 37
Page: 3-12
PDF size: 608.87 Kb.


ABSTRACT

Recent background in neurosurgery for psychiatric disorders can be placed in the mid XIXth century. Buckhartd made partial resection of frontal cortex in 6 psychiatric patients, with successful results in 4 of them, but important side effects prevented the development of this scientific approach. In 1936 Egas Moniz and Almeida Lima performed a new neuro-psychiatric technique for treatment of several psychiatric disorders, named prefrontal lobotomy. Results of this treatment won Moniz a Nobel Prize in 1949, and encouraged Freeman and Watts to further develop this kind of surgery in United States of America.
Unfortunately, the knowledge about pathophysiology was not sufficient to make a precise indication of surgery in this patients. Between 1935 and 1950, nearly 20,000 surgeries were performed in doubtful conditions, showing important side effects. On the other hand, the emergency of new drugs for the treatment of psychiatric disorders along with the absence of regulation stopped development of “"psychosurgery"”.
However, in 1946 Spiegel and Wacis started stereotactic age of neurosurgery, thus reducing risk and complication of this procedures. Nowadays, World Health Organization accepted four neurosurgery procedures for psychiatric disorders: cingulotomy, anterior capsulotomy, subcaudate tractotomy and limbic leucotomy (a combination of cingulotomy and subcaudate tractotomy). Best results for this kind of surgery are shown for affective disorders (major depression disorder, bipolar disorder, anxiety disorders) and obsessive compulsive disorder. Besides, in clinical research protocols the inclusion criteria for neurosurgical procedures in psychiatry have been well defined. Both patients’ selection and medical team must be monitored by ethics committee. Currently, the requirements to consider a patient as a candidate for psychiatric neurosurgery are:
1. Clear psychiatric diagnosis in accordance to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM.IV-TR).
2. Evidence of refractivity (improved of symptoms inferior to 50%) to conventional treatments provided by two different psychiatrists.
3. A minimum of 5 years of evolution in symptoms.
4. The ethics committee must monitor surgical and research protocols in a case by case basis. The Committee will made sure that patient and relatives understand medic and psychiatric inclusion criteria.
5. Neurosurgical procedures will only be indicated when the patient is able to understand and accept any details presented to him or her in a formal Consent Form.
6. Neurosurgery psychiatric clinical teams should be integrated by:
a) Stereotactic neurosurgeons whose have experience in psychiatric neurosurgery, neuromodulation, radiosurgery and clinical issues.
b) A psychiatric team with ample experience in psychiatric conditions and research protocols.
c) In case both teams of specialists are not experienced enough in the field of psychiatric neurosurgery, they must look for technical advice from other neurosurgical psychiatric centers.
d) Psychiatric neurosurgery can only be performed to recover healthy conditions and relief suffering. These interventions must always be performed with the sole objective of improving patients quality of life and they must never be used for political, legal or social purposes.
Finally, Neuromodulation has shown to be a useful and safe tool in relief of psychiatric disorders. Neuromodulation’s effects are reversible and they can adjusted to patient. Nowadays, Neuromodulation is being used in patients with major depression, obsessive compulsive disorder and Tourette’´s illness.


REFERENCES

  1. AMERICAN PSYCHIATRIC ASSOCIATION: Manual de Diagnóstico y Estadística de los Trastornos Mentales (DSM IV) Versión Española. Editorial Masson, 2000.

  2. ANDERSON CA, ARCINIEGAS DB: Neurosurgical interventions for neuropsychiatric syndromes. Curr Psychiatry Rep, 6(5):355-63, 2004.

  3. BALLANTINE HT, THOMAS EK: Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry, 22:807819,1987.

  4. BEST M, WILLIAMS M, COCCARO E: Evidence for a disfunctional prefrontal circuit in patients with an impulsive aggressive disorder. PNAS, 99:8448-8453, 2002.

  5. BINDER K, BERMANS I: Modern neurosurgery for psychiatric disorders. Neurosurgery, 47:9-23, 2000.

  6. COSGROVE R, SCOTT R: Psychosurgery. Neurosurgery Clinics North America, 6:167-175, 1995.

  7. EICHELMAN B: The limbic system and aggression in humans. Neurosci Biobehav Rev, 7:391-394, 1983.

  8. FELDMAN R, GOODRICH J: Psychosurgery: A historical overview. Neurosurgery, 48:647-659, 2001.

  9. FREEMAN W, WATTS JW: Prefrontal lobotomy in the treatment of mental disorders. South Med J, 93:13791385,1937.

  10. FULTON JF, JACOBSEN CF: The functions of the frontal lobes: a comparative study in Monkeys, chimpanzees, and man. En: Abstracts of the Second International Neurological Congress, 61-73, 1935.

  11. KELLEY D, RICHARDSON A: Stereotactic limbic leucotomy: Neurophysiological aspects and operative technique. Br J Surgery, 123:133-140, 1973.

  12. KNIGHT GC: The orbital cortex as an objective in the surgical treatment of mental illness. The development of the stereotactic approach. Br J Surgery, 51:114-124, 1954.

  13. HANSEN H, ANDERSEN R, THEILGAARD A: Stereotactic psychosurgery: A psychiatric and psychological investigation of the effects and side effects of the interventions. Acta Psychiatr Scand, 301:1, 1992.

  14. HARVEY PD, MOHS RC,DAVIDSON M: Leukotomy and aging in chronic schizophrenia: A follow up study 40 years after psychosurgery. Schizophr Bull, 19:723-725, 1993.

  15. HAY P: Treatment of obsessive-compulsive disorder by psychosurgery. Acta Psychiatr Scand, 87:197-199, 1993.

  16. HERMANN RC, DORWART RA,HOOVER CW:Variation in ECT use in the United States. Am J Psychiatry, 152:869875, 1995.

  17. HEATH RG, MONROE RR, MICKLE WA: Stimulation of the amygdaliod nucleus in a schizophrenic patient. Am J Pschy, 111:862-863, 1954.

  18. ISKANDAR BJ, NASHHOLD BS: History of functional neurosurgery. Neurosurg Clin North Am, 6:1-25, 1995.

  19. KAPLAN S: Sinopsis de Psiquiatria. Octava edición, Editorial Panamericana, 1280-1283, 2000.

  20. MARINO R, COSGROVE R: Neuropsychiatry of the basal ganglia. Psychiatric Clinics North America, 20:934-943, 1997.

  21. MONIZ E: How I Came to Perform Leucotomy. Psychosurgery. Lisbon, 1948.

  22. NARABAYASHI H, UNO M, LONG R: Long range results of stereotaxic amygdalotomy for behavior disorders. Confin Neurol, 27:168-171, 1966.

  23. NUTTIN BJ, GABRIELS L: Electrical stimulation of the anterior limbs of the internal capsules in patients with severe obsessive-compulsive disorder: anecdotal reports. Neurosurgery Clinics North America, 14:267-274, 2003.

  24. RUCK C, ANDREEWITCH S, FLYCT K, EDMAN G, HAKAN N: Capsulotomía para los trastornos de ansiedad resistentes al tratamiento. Am J Psychiatry (ed esp), 6:365-373, 2003.

  25. SANO K, YOSHIOKA M, OGASHIWA M, ISHIJIMA B, OHYE C: Postero-medial hypothalamotomy in the treatment of aggressive behaviors. Confin Neurol, 27:164-167, 1966.

  26. SANO K, YOSHIOKA M,OGASHIWA M, ISHIJIMA B, OHYE C: Autonomic, somatomotor and electroencephalographic responses upon stimulation of the hypothalamus and the rostral brain stem in man. Confin Neurol, 29:257-261, 1967.

  27. SCHVARTZ JR, DRIOLLET R, RIOS E: Stereotactic hypotalamotomy for behaviour disorders. J Neurol Neurosurg Psych, 35:356-359, 1972.

  28. SPIEGEL EA, WYCIS HT: Physiological and psychological results of Thalamotomy. Procr Soc Med, 42:89-93, 1949.

  29. SPRANGLER WJ, COSGROVE GR: Magnetic resonance image-guide stereotactic cingulotomy for intractable psychiatric disease. Neurosurgery, 38(6):1071-78, 1996.

  30. STROM-OLSEN R, CARLISLE S: Bi-frontal stereotactic tractotomy: A follow-up study of its effects on 210 patients. Br J Psychiatry, 118:141-145, 1998.

  31. SWAYSE VW: Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935-1954): a historical overview. Am J Psychiatry, 152:505-515, 1995.

  32. SWEET WH: Treatment of medically intractable mental disease by limited frontal leucotomy: justifiable?. New England J Medicine, 289:1117-1125, 1973.

  33. RASMUSSEN SA, EISEN J: Treatment strategies for chronic and refractory obsessive-compulsive disorder. J Clin Psychiatry, 58(Supl 13):9-13, 1997.

  34. VELASCO F, VELASCO M, JIMENEZ F, VELASCO AL, BRITO F, RISE M, CARRILLO-RUIZ JD: Predictors in the treatment of difficult to control seizures by electrical stimulation of the centromedian thalamic nucleus. Neurosurgery 47:295-305, 2000.

  35. VELASCO F, VELASCO M, JIMENEZ F, VELASCO AL, BRITO F, RISE M: The role of thalamic electrical stimulation in the control of seizures. En: Textbook of stereotactic and functional neurosurgery. Ed. Guildenberg PL, Tasker RR. McGraw-Hill. pp: 1933-1940, Nueva York, 1998.

  36. VELASCO F, VELASCO M, VELASCO AL, MENEZ D, ROCHA L: Electrical stimulation for epilepsy: stimulation of hippocampal foci. Stereotact Funct Neurosurg, 77:223-227, 2001.

  37. VELASCO F, JIMENEZ F, PEREZ M, CARRILLO-RUIZ D, VELASCO L, CEVALLOS J, VELASCO M: Electrical stimulation of the prelemniscal radiation in the treatment of Parkinson´s disease. An old target revised with new techniques. Neurosurgery, 49:1-14.38, 2000.




2020     |     www.medigraphic.com