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PubMed1978

EEG studies on patients with chronic obsessive-compulsive neurosis before and after psychosurgery (stereotaxic bilateral anterior capsulotomy).

In 35 patients with chronic severe obsessive-compulsive neurosis the EEG was studied before, shortly after (10 days) and 1--2 years after a psychosurgical intervention (stereotaxic bilateral anterior capsulotomy). The preoperative EEG was completely normal or borderline in most of the patients (94%). After surgery EEG changes appeared in 90% of the patients. In most of them (75%) these consisted in bilaterally synchronous bursts of rhythmic slow waves with a maximum in the frontal regions. No consistent change of the alpha activity could be found. At the follow-up examinations most of the EEGs (79%) showed the same pattern as at the preoperative control. No focal or epileptiform abnormalities were observed, either at the immediate postoperative or at the follow-up examination.

Adult↗
PubMed1976

From phrenology to psychosurgery and back again: biological studies of criminality.

Characteristics of scientific research--careful definition of the problem, random sample selection, relevant control groups, careful measurement techniques, and caution in drawing conclusions from the data--are employed to evaluate the argument for constitutional, genetic, mental, endocrinal, and neurological theories of crime causation. A historical continuity in assumptions and methodological flaws is revealed between contemporary studies of the biological correlates of crime and their earlier counterparts. Social and political ramifications of biomedical research are considered.

Anthropology, Physical↗
PubMed2003

Psychosurgery.

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Electric Stimulation Therapy↗
PubMed1995

Frontal leukotomy and related psychosurgical procedures in the era before antipsychotics (1935-1954): a historical overview.

OBJECTIVE: This article provides an overview of the history of psychosurgery as a treatment for psychiatric illnesses. METHOD: The author reviewed articles describing psychosurgery between 1935 and 1954 in order to summarize surgical techniques, clinical indications for surgery, patient selection, complications, and outcome. RESULTS: Patients were operated on for a wide variety of psychiatric illnesses. Initially, a large number of uncontrolled studies reported considerable therapeutic benefit in at least one-third of the patients operated on. Complications with the early surgical techniques included hemorrhage, seizures, infection, and personality changes. Surgical techniques proliferated in hopes of achieving greater therapeutic benefit while minimizing detrimental side effects. As psychosurgery became more widely accepted, its principal supporters began to use it as a routine therapy. A number of uncontrolled and controlled short-term studies supported the efficacy of psychosurgery, but long-term controlled studies showed mixed results. CONCLUSIONS: Psychosurgery was promoted as a treatment for patients who had shown little or no response to less drastic therapies. In the context of an era when no efficacious treatments were available for psychosis, its use was understandable. However, its history illustrates the importance of critical evaluation of new treatments in the context of long-term controlled outcome studies, the natural course of specific illnesses, and an understanding of brain physiology.

Behavior Control↗
PubMedDate not supplied

[Psychosurgical treatment of malignant OCD: three case-reports].

Surgery can be proposed for some patients affected by psychiatric diseases such as severe, disabling and refractory affective disorders (depression), OCD and chronic anxiety states. It can be performed after a period of evolution of minimum 5 Years and after all other classical treatments have failed. For the last Years, different stereotactic techniques have been used: capsulotomy, cingulotomy, subcaudate tractotomy and limbic leukotomy, performed by radiofrequency thermolesions or radiosurgery (g rays). In the case of OCD, these procedures are supposed to affect some of the neural circuits between the frontal lobes and different structures of the limbic system, considered as central to OCD symptoms. As they cause smaller cerebral lesions than earlier surgical techniques (mostly open surgery techniques), modern stereotactic approaches have less clinical side effects, primarily less deficit in emotional reactivity and motivation. This type of treatment offers some hope to patients seriously disabled by OCD. These surgeries and especially their main side effects are mentioned briefly in this Article. The most current indications for psychosurgery are severe OCD and chronic major depressive disorder. The level of stress should be significant and assessed by clinical and social functioning scale scores (for the OCD: Y-BOCS>25, GAF>50). Patients affected by demential disorders, sociopathic or paranoiac personality disorder, substance abuse should be excluded as well as patients aged 65 Years over and less than 18 Years. Several studies evaluating the results of the surgical treatment showed significant improvement in 54% of cases. and a moderate improvement in 27% of them. These results seem unchanged a few Years later in 56% of cases. Despite the lack of controlled trials of neurosurgery and several bias in published reports, evidence suggests that the condition of intractable OCD patients may improve after this surgery. Although capsulotomy and cingulotomy are mainly used, the superiority of any of these four surgical techniques has not been established yet. In this Article, we reported 3 "malignant" OCD cases treated by different psychosurgery techniques: 2 of the cases showed a clinical improvement, whereas the third did not -benefit from surgery. All of them were suffering of OCD since childhood with a gradual clinical impairment, unless the -second patient who presented a severe impairment following an accident causing a ten-day coma. In all three cases social consequences of OCD were important: negative socio-professional and family-life consequences and depressive complication with suicide risk. All patients remained unresponsive or showed a very transient reaction to the other forms of therapy, including varied pharmacotherapy (potentiation pharmacotherapy strategies included), intensive psychotherapy, behavioural therapy and electro-convulsive therapy. Pre- and post-operative assessment included neurological, radiological, psychometric and neuropsychological examination. The free and informed consent of the patient was always required before surgery, notifying the nature of the procedure, the potential risks and outcome. The first patient benefited of a bilateral anterior cingulotomy by thermocoagulation in stereotactic conditions, followed, four years later, by a second complementary one because of a relapse which occurred a few months after the first intervention. A clinical improvement was noticed over a period of two years, though it was not sufficient according to the patient. The second patient benefited of a stereotactic cingulotomy associated with a limbic leucotomy: it was initially efficient on OCD as well as on thymic symptoms. Nevertheless the positive evolution on OCD is not perceived by the patient and has not been assessed until now by clinical rating scales. Anterior cingulotomy is undergone in the third case, who showed a significant improvement. Despite clomipramine administered secondary to the surgery, a slight relapse of obsessive ideas was noticed six months later. The postoperative side effects were transient and regressive after a few months; they were observed especially in the case of tractotomy (oedema and transient frontal syndrome). On the whole, morbidity seemed more important with extensive lesions, whereas recurrence rate may be higher with smaller lesions. We did not observe any consequences on personality or on cognitive functions of these patients. No additional -deficits were observed after surgery. Further research is needed in order to determine the optimal site and size of the lesions in terms of efficacy and safety. Although psychosurgery is still controversial from an ethical view point, this treatment appears to be an ultimate solution for these severe disabled patients. Psychosurgery is a safe and relatively effective treatment which should be carried out by an expert multidisciplinary team in these disorders; surgery should be considered as part of an entire treatment program including an appropriate psychiatric rehabilitation part. Research in this field is currently focused on MRI-guided basal ganglia stimulation techniques which would allow to target specific structures in a reversible way.

Brain↗
PubMed2004

Neurosurgical interventions for neuropsychiatric syndromes.

Psychosurgical procedures have been used for the treatment of intractable mental illness for more than 50 years. With improvements in surgical techniques, including new implantable stimulators, advances in functional neuroimaging, and progress in our fundamental understanding of the pathophysiology of mental illness there is a renewed interest in neurosurgical treatment of refractory psychiatric illness. This article will review the history of psychosurgery and recent developments in surgical techniques and implantable devices used in this context. The results of psychosurgery for the treatment of several psychiatric conditions and neuropsychiatric symptoms will be presented, including obsessive-compulsive disorder, Tourette's syndrome, depression, anxiety, aggression, self-injurious behavior, and schizophrenia. Lastly, a perspective on the current and future role of psychosurgery for the treatment of mental illnesses will be discussed.

Brain↗