2009, Number 1
<< Back Next >>
Arch Neurocien 2009; 14 (1)
The rol of surfery of limbic system in the treatment of anorexia and bulimia
Hernández SM, Zarate MA, Valencia GFJ, Menéses LO, Ochoa MMG, Torres GS, Lucino-Castillo J, Martínez SB
Language: Spanish
References: 31
Page: 11-21
PDF size: 258.28 Kb.
ABSTRACT
Purpose: the psychosurgery or neurosurgery for psychiatric disorders has had a long and controversial history, until the present with contributions from different doctors as the Swiss psychiatrist Gottlieb Burckhart, doctors Egas Moniz. There have been enthusiastic collaborators as well as detractors. The evolution of anesthetic and surgical techniques has given to neurological surgery for psychiatric disorders to be a possible alternative treatment. The most important advances in esterotaxic techniques have been proved to be a safe procedure and with favorable results.
Methods: we present three cases of patients with eating disorders; they were presented to a committee of psychosurgery to be evaluated. Zamboni’s thalatomy (with bilateral involvement of the lamella medialis) and the limbic leucotomies Kelly’s modified. The latter consisting in a combined method in which injuries are performed stereotacticly approximately 6 mm in diameter through cryogenics or thermocoagulation specific targets in 2 points: anterior capsule and cingulum, seeking to disrupt this tract talamocortical (corticostriatalthalamic tract), fibers passing through the arm above the internal capsule (frontal radiation trough thalamus) and connecting with the orbitofrontal cortex and the limbic system bidirectional connections between the frontal lobes (prefrontal areas, limbic circuit) and the prefrontal corticopontine tract.
Results: in 12 to 36 months for assessment, we found significant improvement in symptoms related to depression, and disability in the scale of Sheehan, improvement in aggressiveness. Do not have significative (p value) improvement in obsessive-compulsive disorder by the scale of Yale / Brown, anxiety and impulsivity, but they have to statistical tendence to clinical improvement.
Conclusions: we have found the association of eating disorders and obsessive-compulsive disorder to improve symptoms OCD patients with eating disorders who have not responded to treatment. This may be an alternative safe and effective.
REFERENCES
Robin, Eugene D. El juramento hipocrático en nuestros días. Plas Res Neurol 2003; 2 (2):131-2.
Bermans J Iskandar. History of functional neurosurgery. Neurosurg Clin North America 1995; 6 (1): 1-22.
Feldman RP. Contemporary Psychosurgery. J Neurosurg 2001; 95 (1): 944-56.
Feldman RP. Psychosurgery: a historical overview. Neurosurgery 2001; 48 (3): 647-57.
Gerhard Heinze J, González Olvera J. El papel actual de los procedimientos microquirúrgicos en los padecimientos mentales. Salud Mental 2006; 29 (1): 1-2.
Heller CA. Surgery of the mind and mood: a mosaic of issues in time and evolution. Neurosurgery 2006; 59: 720-39.
Jiménez Ponce F. Introducción a la neurocirugía psiquiátrica. Salud Mental 2006; 29 (1): 3-12.
Macmillan M. Phineas Gage’s contributions to brain surgery. Aust J Hist Neurocien 1995;5(2):2.
Meneses Luna O. Estudio de casos: beneficios de la psicocirugía en pacientes con agresividad y trastorno obsesivo compulsivo refractarios. UNAM 2006;62.
Sabbatini RME. The History of psychosurgery. Brain Mind Magazine 1997; 6: 8-15.
Snaith RP. Psicocirugía: controversia e investigación. Br J Psich 1994; 165: 582-4.
Binder DK, Bermans JI. Modern neurosurgery for psychiatric disorders. Neurosurgery 2000; 27 (1): 9-23.
Del Valle Ramiro. Radiocirugía psiquiátrica con Gamma Knife. Salud Mental 2006; 29 (1): 18-27.
Fodstad H. Treatment of chronic obsessive compulsive status with stereotactic anterior capsulotomy. Act Neurochir 1982; 62 (1): 1-23.
Jenike Ma. Neurosurgical treatment of obsessive compulsive disorders. Br J Psichiatry 1998; 12: 173: 537.
Kim Mc. Review of long-term results of stereotactic psychosurgery. Neurol Med Chir 2002; 42 (9): 365-71.
López AC. Update on neurosurgical treatment for obsessive compulsive disorder. Rev Bras Psiquiatr 2004; 26 (1): 62-6.
Mindus P. Neurosurgical treatment for refractory obsessivecompulsive disorder: implications for understanding frontal lobefunction. J Neuropsych Clin Neuroscien 1994; 6.
Montoya A. Magnetic resonance imaging-guided stereotactic limbic leukotomy for treatment of intractable psychiatric disease. Neurosurgery 2002; 50 (5): 1043-52.
Polosan M. Psychosurgical treatment of malignant OCD. Encephale 2003; 29 (6): 545-52.
Cosgrove R, Scott R. Psychosurgery neurosurgery clinics North America, Gildenberg PH (ed). WB Saunders and Co 1995.
Fanghanel G. La neurocirugía en los trastornos de la alimentación: una alternativa posible?. Salud Mental 2006; 29 (1): 28-36.
Morgan JF, Crisp AH. Use of leucotomy for intractable anorexia nervosa: a long-term follow-up study. Int J Disord 2000; 27(3): 249-58.
Zamboni R. Dorsomedial thalamotomy as a treatment for terminal anorexia: a report of two cases. Acta Neurochir 1993; 58: 34-5.
Audenaert K. Decreased 5-HT2a receptor binding in patients with anorexia nervosa. J Nucls Med 2003; 44: 163-9. 27. Fairburn CG, Harrison JP. Eating disorders. Lancet 2003; 361 (1):407-16.
Fassino S. Anger and personality in eating disorders. J Psychosomatic Res 2001; 51: 757-64.
Matsunaga H. Clinical characteristics in patiens with anorexia nervosa and obsessive-compulsive disorder”. Psychol Med 1999;29(2):407-14.
Toro Josep. Anorexia nerviosa. Med Clin (Barc) 2001;117:334-5.
Thompson Charles F. Biblia de referencia Thompson”. Editorial Vida, Miami, Florida, EUA. 1997.
Bulik CM. Prevalence, heritability and prospective risk factors for anorexia nervosa. Arch Gen Psychiatry 2006; 63:305-12.
Miranda A, Méndez SN. Trastornos de la alimentación. Med Sur 2000; 7 (4):131-5.
Full text