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Status of neurosurgery for mental disorder in Scotland: Selective literature review and overview of current clinical activity

  • Keith Matthews (a1) and Muftah S. Eljamel (a1)
Abstract
Background

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.

Aims

To review the status of ablative neurosurgery for mental disorder and to describe the activities of the Scottish national service.

Method

Relevant literature is reviewed alongside a description of recent clinical activity.

Results

Neurosurgical treatment is offered to a small number of patients severely disabled by otherwise intractable mental disorder. Thereareinequalitiesin 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.

Conclusions

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.

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Copyright
Corresponding author
Professor Keith Matthews, Department of Psychiatry, Ninewells Hospital, Dundee DDI 9SY, UK. Tel: 01382 632121; fax: 01382 633923; e-mail: k.matthews@dundee.ac.uk
Footnotes
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Declaration of interest

K. M. has received payment for lectures on the management of depression from various pharmaceutical companies.

Footnotes
References
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Ballantine, H. T., Bouckoms, A. J., Thomas, E. K., et al (1987) Treatment of psychiatric illness by stereotactic cingulotomy. Biological Psychiatry, 22, 807819.
Bridges, P. K. & Goktepe, E. O. (1973) A review of patients with obsessional symptoms treated by psychosurgery. In Surgical Approaches in Psychiatry (eds Laitinen, L. V. & Livingstone, K. E.), pp.96100. Baltimore, MD: University Park Press.
Bridges, P. K. Bartlett, J. R., Hale, A. S., et al (1994) Psychosurgery: stereotactic subcaudate tractotomy. An indispensable treatment. British Journal of Psychiatry, 165, 599611.
Cosyns, P., Caemaert, J., Haaijman, W., et al (1994) Functional stereotaxic neurosurgery for psychiatric disorders: an experience in Belgium and the Netherlands. Advances and Technical Standards in Neurosurgery, 21, 239279.
CRAG Working Group on Mental Illness (1996) Neurosurgery for Mental Disorder. A Report by a Good Practice Group of the CRAG Working Group on Mental Illness. Scottish Office J2318, 7/96. Edinburgh: HMSO.
Dougherty, D. D., Baer, L., Cosgrove, G. R., et al (2002) Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. American Journal of Psychiatry, 159, 269275.
Drevets, W. C., Price, J. L., Simpson, J. R., et al (1997) Subgenual prefrontal cortex abnormalities in mood disorders. Nature, 386, 824827.
Goktepe, E. O., Young, L. B. & Bridges, P. K. (1975) A further review of the results of stereotactic subcaudate tractotomy. British Journal of Psychiatry, 126, 270280.
Happe, F., Malhi, G. S. & Checkley, S. (2001) Acquired mind-blindness following frontal lobe surgery? A single case study of impaired ‘theory of mind’ in a patient treated with stereotactic anterior capsulotomy. Neuropsychologia, 39, 8390.
Hay, P., Sachdev, P., Cummings, S., et al (1993) Treatment of obsessive compulsive disorder by psychosurgery. Acta Psychiatrica Scandinavica, 87, 197207.
Herner, T. (1961) Treatment of mental disorders with frontal stereotactic thermolesions. A follow-up of 116 cases. Acta Psychiatrica Scandinavica Supplementum, 37, 158.
Hrobjartsson, A. & Gotzsche, P. C. (2001) Is the placebo powerless? An analysis of clinical trials comparing placebo with no treatment. New England Journal of Medicine, 344, 15941602.
Irle, E., Exner, C., Theilen, K., et al (1998) Obsessive-compulsive disorder and ventromedial frontal lesions: clinical and neuropsychological findings. American Journal of Psychiatry, 155, 255263.
Jenike, M. A., Baer, L., Ballantine, H. T., et al (1991) Cingulotomy for refractory obsessive-compulsive disorder. A long-term follow-up of 33 patients. Archives of General Psychiatry, 48, 548555.
Judd, L. L. (1997) The clinical course of unipolar major depressive disorders. Archives of General Psychiatry, 54, 989991.
Kartsounis, L. D., Poynton, A., Bridges, P. K., et al (1991) Neuropsychological correlates of stereotactic subcaudate tractotomy. Brain, 114, 26572673.
Kelly, D. (1980) Anxiety and Emotions: Physiological Basis and Treatment. Springfield, IL: Charles Thomas.
Kiloh, L. G., Smith, J. S. & Johnston, G. F. (1988) Psychosurgery (limbic surgery). In Physical Treatments in Psychiatry (eds Kiloh, L. G., Smith, J. S. & Johnston, G. F.), pp. 277333. Melbourne: Blackwell.
Knight, G. (1965) Stereotactic tractotomy in the surgical treatment of mental illness. Journal of Neurology, Neurosurgery and Psychiatry, 28, 304310.
Lippitz, B. E., Mindus, P., Meyerson, B. A., et al (1999) Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery, 44, 452458.
Malhi, G. & Bartlett, J. R. (1998) A new lesion for the psychosurgical operation of stereotactic subcaudate tractotomy (SST). British Journal of Neurosurgery, 12, 335339.
Marks, I. M., Birley, J. L. & Gelder, M. G. (1966) Modified leucotomy in severe agoraphobia: a controlled serial inquiry. British Journal of Psychiatry, 112, 757769.
Mataix-Cols, D., Rauch, S. L., Baer, L., et al (2002) Symptom stability in adult obsessive-compulsive disorder: data from a naturalistic two-year follow-up study. American Journal of Psychiatry, 159, 263268.
Matthews, K. & Eljamel, M. S. (2001) Neurosurgery for Mental Disorder in Dundee. http://www.show.scot.nhs.uk/mhwbsg/Documents/NMDReport.pdf.
Millan Committee (2001) New Directions: Review of the Mental Health (Scotland) Act 1984. Scottish Executive Publications SE/2001/56. Edinburgh: Stationery Office.
Mindus, P. & Nyman, H. (1991) Normalization of personality characteristics in patients with incapacitating anxiety disorders after capsulotomy Acta Psychiatrica Scandinavica, 83, 283291.
Moniz, E. (1936) Essai, d'un traitement chirurgical de certaines psychoses. Bulletin de l'Académie de Médecin, 115, 385392.
Nuttin, B., Gybels, J., Cosyns, P., et al (1999) Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet, 354, 1526.
Ochsner, K. N., Kosslyn, S. M., Cosgrove, G. R., et al (2001) Deficits in visual cognition and attention following bilateral anterior cingulotomy. Neuropsychologia, 39, 219230.
Ongur, D., Drevets, W. C. & Price, J. L. (1998) Glial reduction in the subgenual prefrontal cortex in mood disorders. Proceedings of the National Academy of Sciences of the USA, 95, 1329013295.
Poynton, A. M., Kartsounis, L. D. & Bridges, P. K. (1995) A prospective clinical study of stereotactic subcaudate tractotomy. Psychological Medicine, 25, 763770.
Rajkowska, G., Miguel-Hidalgo, J. J., Wei, J., et al (1999) Morphometric evidence for neuronal and glial prefrontal cell pathology in major depression. Biological Psychiatry, 45, 10851098.
Royal College of Psychiatrists (2000) Neurosurgery for Mental Disorder. Report from the Neurosurgery Working Group of the Royal College of Psychiatrists (Council Report CR89). London: Royal College of Psychiatrists.
Rush, A. J., George, M. S., Sackeim, H. A., et al (2000) Vagus nerve stimulation (VNS) for treatment resistant depression: a multicenter study. Biological Psychiatry, 47, 276286.
Sackeim, H. A., Rush, A. J., George, M. S., et al (2001) Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects and predictors of outcome. Neuropsychopharmacology, 25, 713728.
Sheline, Y. I., Wang, P. O., Gado, M. H., et al (1996) Hippocampal atrophy in recurrent major depression. Proceedings of the National Academy of Sciences of the USA, 63, 3908 3913.
Skoog, G. & Skoog, I. (1999) A forty-year follow-up of patients with obsessive compulsive disorder. Archives of General Psychiatry, 56, 121127.
Spangler, W., Cosgrove, R., Ballantine, H. T., et al (1996) Magnetic resonance image-guided stereotactic cingulotomy for intractable psychiatric disease. Neurosurgery, 38, 10711078.
Szeszko, P. R., Robinson, D., Alvir, J., et al (1999) Orbital frontal and amygdala volume reductions in obsessive compulsive disorder. Archives of General Psychiatry, 56, 913919.
Tan, E., Marks, I. M. & Marset, P. (1971) Bimedial leucotomy in obsessive – compulsive neurosis: a controlled serial inquiry. British Journal of Psychiatry, 118, 155164.
Vilkki, J. (1977) Late psychological and clinical effects of subrostral cingulotomy and anterior mesoloviotomy in psychiatric illness. In Neurosurgical Treatment in Psychiatry, Pain and Epilepsy (eds Sweet, W. H., Obrador, S. & Martin-Rodriguez, J.), pp. 253259. Baltimore, MD: University Park Press.
Waziri, R. (1990) Psychosurgery for anxiety and obsessive-compulsive disorders. In Handbook of Anxiety (vol. 4) (eds Noyes, R., Roth, M. & Burrows, G.). Amsterdam: Elsevier.
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Status of neurosurgery for mental disorder in Scotland: Selective literature review and overview of current clinical activity

  • Keith Matthews (a1) and Muftah S. Eljamel (a1)
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