Ablative Surgery for Neuropsychiatric Disorders: Past, Present, Future

Chodakiewitz, Yosef; Williams, John R.; Chodakiewitz, Jacob; Cosgrove, G. Rees

doi:10.1007/978-94-017-9576-0_5

Cited by 4 publications

(15 citation statements)

References 106 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The left y-axis shows the relative growth per year for the sets A and B. Modern psychiatric neurosurgery procedures are much safer and more effective than their predecessors [2,38]. Therefore, it is necessary to re-evaluate the role of historical experiences with psychiatric neurosurgery in assessing the modern use of these techniques.…”

Section: Footnote 2 (Continued)mentioning

confidence: 99%

“…Furthermore, the present distinction between modern ablative procedures as successors of historical psychosurgery and DBS as a substantially different approach needs to be questioned, as both psychiatric DBS and modern ablative psychiatric neurosurgery represent significantly improved successors of the historical psychosurgery [8,39]. Furthermore, DBS target selection is largely based on prior knowledge about lesioning [2].…”

Section: Footnote 2 (Continued)mentioning

confidence: 99%

“…Functional stereotactic neurosurgery was primarily developed and used to replace leucotomy; then it was extended into the treatment of pain, epilepsy and movement disorders [1]. Until the 1970 s, neurosurgery for psychiatric disorders has been used in hundreds of thousands of patients with mental illness [2]- [5]. However, the morbidity and neurological sequelae of leukotomies became more and more evident, and patient selection criteria as well as the procedure's efficacy were questioned more critically [2].…”

Section: Introductionmentioning

confidence: 99%

“…Until the 1970 s, neurosurgery for psychiatric disorders has been used in hundreds of thousands of patients with mental illness [2]- [5]. However, the morbidity and neurological sequelae of leukotomies became more and more evident, and patient selection criteria as well as the procedure's efficacy were questioned more critically [2]. Psychosurgery was nearly completely abandoned in the mid-1970 s because of public criticism and because of the development of chlorpromazine and other antipsychotic drugs [5].…”

Section: Introductionmentioning

confidence: 99%

“…They signify that products sold in the EEA have been assessed to meet high safety, health, and environmental protection requirements [24]. 6 For detailed descriptions of the different approaches and their mechanisms of action, we recommend the textbooks [4], [26], [27], and the papers [2], [4], [12], [16], [17], [28]- [35].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

et al. 2022

View full text Add to dashboard Cite

Background Psychiatric neurosurgery is experiencing a revival. Beside deep brain stimulation (DBS), several ablative neurosurgical procedures are currently in use. Each approach has a different profile of advantages and disadvantages. However, many psychiatrists, ethicists, and laypeople are sceptical about psychiatric neurosurgery. Methods We identify the main concerns against psychiatric neurosurgery, and discuss the extent to which they are justified and how they might be overcome. We review the evidence for the effectiveness, efficacy and safety of each approach, and discuss how this could be improved. We analyse whether and, if so, how randomised controlled trials (RCTs) can be used in the different approaches, and what alternatives are available if conducting RCTs is impossible for practical or ethical reasons. Specifically, we analyse the problem of failed RCTs after promising open-label studies. Results The main concerns are: (i) reservations based on historical psychosurgery, (ii) concerns about personality changes, (iii) concerns regarding localised interventions, and (iv) scepticism due to the lack of scientific evidence. Given the need for effective therapies for treatment-refractory psychiatric disorders and preliminary evidence for the effectiveness of psychiatric neurosurgery, further research is warranted and necessary. Since psychiatric neurosurgery has the potential to modify personality traits, it should be held to the highest ethical and scientific standards. Conclusions Psychiatric neurosurgery procedures with preliminary evidence for efficacy and an acceptable risk–benefit profile include DBS and micro- or radiosurgical anterior capsulotomy for intractable obsessive–compulsive disorder. These methods may be considered for individual treatment attempts, but multi-centre RCTs are necessary to provide reliable evidence.

show abstract

Section: Footnote 2 (Continued)mentioning

confidence: 99%

Section: Footnote 2 (Continued)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Concerns About Psychiatric Neurosurgery and How They Can Be Overcome: Recommendations for Responsible Research

et al. 2022

View full text Add to dashboard Cite

show abstract

Should DBS for Psychiatric Disorders be Considered a Form of Psychosurgery? Ethical and Legal Considerations

2017

View full text Add to dashboard Cite

Deep brain stimulation (DBS), a surgical procedure involving the implantation of electrodes in the brain, has rekindled the medical community's interest in psychosurgery. Whereas many researchers argue DBS is substantially different from psychosurgery, we argue psychiatric DBS-though a much more precise and refined treatment than its predecessors-is nevertheless a form of psychosurgery, which raises both old and new ethical and legal concerns that have not been given proper attention. Learning from the ethical and regulatory failures of older forms of psychosurgery can help shed light on how to address the regulatory gaps that exist currently in DBS research. To show why it is important to address the current regulatory gaps within psychiatric DBS, we draw on the motivations underlying the regulation of earlier forms of psychosurgery in the US. We begin by providing a brief history of psychosurgery and electrical brain stimulation in the US. Against this backdrop, we introduce psychiatric DBS, exploring current research and ongoing clinical trials. We then draw out the ethical and regulatory similarities between earlier forms of psychosurgery and psychiatric DBS. As we will show, the factors that motivated strict regulation of earlier psychosurgical procedures mirror concerns with psychiatric DBS today. We offer three recommendations for psychiatric DBS regulation, which echo earlier motivations for regulating psychosurgery, along with new considerations that reflect the novel technologies used in DBS.

show abstract