Predicting response to psychiatric surgery: a systematic review of neuroimaging findings

Abstract

Background: Psychiatric surgery, including deep brain stimulation and stereotactic ablation, is an important treatment option in severe refractory psychiatric illness. Several large trials have demonstrated response rates of approximately 50%, underscoring the need to identify and select responders preoperatively. Recent advances in neuroimaging have brought this possibility into focus. We systematically reviewed the psychiatric surgery neuroimaging literature to assess the current state of evidence for preoperative imaging predictors of response. Methods: We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) frameworks, and preregistered it using PROSPERO. We systematically searched the Medline, Embase and Cochrane databases for studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in patients who underwent psychiatric surgery. We recorded and synthesized the methodological details, imaging results and clinical correlations from these studies. Results: After removing duplicates, the search yielded 8388 unique articles, of which 7 met the inclusion criteria. The included articles were published between 2001 and 2018 and reported on the outcomes of 101 unique patients. Of the 6 studies that reported significant findings, all identified clusters of hypermetabolism, hyperconnectivity or increased size in the frontostriatal limbic circuitry. Limitations: The included studies were few and highly varied, spanning 2 decades. Conclusion: Although few studies have analyzed preoperative imaging for predictors of response to psychiatric surgery, we found consistency among the reported results: most studies implicated overactivity in the frontostriatal limbic network as being correlated with clinical response. Larger prospective studies are needed. Registration: www.crd.york.ac.uk/prospero/display_record.php?RecordID=131151.

Happy Birthday “One Flew Over the Cuckoo's Nest”: A Momentous Tale in the Quest for an Effective and Ethical Approach to Psychosurgery

“…Although few studies have analysed preoperative imaging to predict response to psychiatric surgery ( N = 101 patients), most studies implicate hyperactivity in the frontostriatal limbic network as correlating with clinical response. 26,27 There are no meta-analyses on epidural stimulation. While enthusiasm for DBS treatment in TRD has been tempered by recent randomized trials, a meta-analysis reveals a significant effect for DBS in the treatment of TRD ( N = 186 patients).…”

Neurosurgical Interventions for Umpteen Psychological Afflictions: a Substantial Cross-Disciplinary Clinical Abridged Frame of Reference

“…Neuromodulation operation is placing some electrodes in the cerebral cortex that modify the networks of neurons. Notwithstanding breakthroughs in medications for managing several mental diseases such as anxiety-related illnesses, obsessive-compulsive illness, depressive symptoms, as well as psychosis, numerous people develop resistance to drug intervention (Davidson, et al (2020). [2]).…”

“…Notwithstanding breakthroughs in medications for managing several mental diseases such as anxiety-related illnesses, obsessive-compulsive illness, depressive symptoms, as well as psychosis, numerous people develop resistance to drug intervention (Davidson, et al (2020). [2]). Neuromodulation operation is considered the final option by practitioners for the management of these individuals.…”