Differential Approach to Psychosurgery of Obsessive Disorders

Korzenev, A.; Shoustin, Vladimir A.; Anichkov, A D; Polonskiy, Juriy Z.; Nizkovolos, V. B.; Oblyapin, Andrey V.

doi:10.1159/000099929

Cited by 9 publications

(7 citation statements)

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“…[9][10][11][12][13][14][15][16][17][18] Chronic pain may be viewed as the byproduct of feedforward loops, through which pain signals are operantly reinforced and sustained. 72 Obsessive-compulsive disorder could involve a similar process.…”

Section: Discussionmentioning

confidence: 99%

“…72 Obsessive-compulsive disorder could involve a similar process. [13][14][15][16][17] The ACC may play an essential role in these disorders by either amplifying or attenuating the tendency of people to continuously respond, emotionally and behaviorally, to pain or other salient stimuli. 19,20 These findings have implications for potential development of future neuropsychiatric interventions that might effect subtle change in cingulate functioning to treat pain and other behavioral disorders.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6] Blunted ACC activation has been demonstrated in patients with dysphoria and depression, 7,8 and lesions of the ACC lead to improvement in certain psychiatric disorders. 7,[9][10][11][12][13][14][15][16][17] Cingulotomy has also been shown to have efficacy in the treatment of chronic intractable pain, 13,[18][19][20][21] although it is not clear whether the procedure reduces the actual sensation of pain or reduces the patient's emotional and behavioral reactivity to pain. 19,20 The ACC is intricately connected to cortical, limbic, and subcortical structures via afferents from the lateral frontal and parietal regions and efferent pathways to the amygdala, nucleus accumbens, septum, and basal ganglia.…”

mentioning

confidence: 99%

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Alteration of Intention and Self-Initiated Action Associated With Bilateral Anterior Cingulotomy

Cohen

Kaplan²,

Zuffante³

et al. 1999

JNP

138

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Neuropsychological manifestations of bilateral anterior cingulate cortex lesions were studied in patients treated with cingulotomy for chronic intractable pain. Cingulotomy patients more than 1 year postsurgery were contrasted with nonsurgical chronic pain patients. Patients were assessed on a neuropsychological battery, including measures of response intention, initiation, generation, and persistence. Cingulotomy patients were intact across most cognitive domains, but they showed deficits of focused and sustained attention as well as mild executive dysfunction. Self-initiated responding--including spontaneous verbal utterances and unstructured design fluency--was most impaired. Results indicate that the greatest impact of cingulotomy lesions is on response intention and self-initiated behavior, with reduced behavioral spontaneity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Alteration of Intention and Self-Initiated Action Associated With Bilateral Anterior Cingulotomy

Cohen

Kaplan²,

Zuffante³

et al. 1999

JNP

138

View full text Add to dashboard Cite

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“…Several years later, Korzenev and colleagues36 published results of their surgical treatment of 4 intractable TS patients. They concluded that stereotactic surgery was an effective method of treatment for severe incurable TS.…”

Section: Ablative Proceduresmentioning

confidence: 99%

Surgery in Tourette syndrome

2004

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Tourette syndrome (TS) is a neuropsychiatric disorder with onset in early childhood. It is characterized by tics and often accompanied by disturbances in behavior, such as obsessive-compulsive disorder (OCD). In most cases, the disorder is self-limited or can be treated by medication or behavioral therapy. In a small percentage, however, symptoms are intractable to any conservative treatment. Since 1955, various attempts have been made to treat these patients through neurosurgical procedures. The target sites have been diverse and include the frontal lobe (prefrontal lobotomy and bimedial frontal leucotomy), the limbic system (limbic leucotomy and anterior cingulotomy), the thalamus, and the cerebellum. Combined approaches have also been tried such as anterior cingulotomies plus infrathalamic lesions. The results have often been unsatisfactory or major side effects have occurred, such as hemiplegia or dystonia. Our review of the literature from 1960 until 2003 revealed 21 reports and 3 descriptions in textbooks covering about 65 patients in total who had undergone ablative procedures for intractable TS, the first being reported in 1962. In 1999, deep brain stimulation (DBS) was introduced as a new approach for intractable TS. To date, 3 patients have been reported who underwent bilateral thalamic stimulation, with promising results on tics and obsessive-compulsive symptoms.

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“…This involved a 19-year-old man with TS and associated OCB who underwent bilateral cryothalamotomy (ventrolateral nuclei) with good results observed at a 1-year follow-up. Several years later, Korzenev and colleagues [29] published results of their surgical treatment of 4 intractable TS patients. They concluded that stereotactic surgery was an effective method of treatment for severe incurable TS.…”

Section: Surgical Therapymentioning

confidence: 99%