Stereotactic Limbic Leucotomy: A Preliminary Report on Forty Patients

Kelly, Desmond; Richardson, Alan; Mitchell-Heggs, Nita; Greenup, J.; Chen, C.; Hafner, R. Julian

doi:10.1192/bjp.123.2.141

Cited by 89 publications

(38 citation statements)

References 14 publications

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“…8 The limbic leukotomy, a combination of both the cingulotomy and subcaudate tractotomy, was introduced in the early 1970s for patients who failed to respond to cingulotomy alone. 37 These lesioning procedures have provided significant benefit to thousands of treatment-resistant OCD patients over 4 decades, and are still in use today. 15,27 The success of modern DBS for movement disorders and the demonstrated efficacy of lesional surgery for OCD paved the way for the extension of DBS to psychiatric disorders.…”

Section: Historical Perspectivementioning

confidence: 99%

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Mian

Campos

Sheth

et al. 2010

FOC

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Obsessive-compulsive disorder (OCD) is a psychiatric illness that can lead to chronic functional impairment. Some patients with severe, chronic OCD have been treated with ablative neurosurgical techniques over the past 4 decades. More recently, deep brain stimulation (DBS) has been investigated as a therapy for refractory OCD, and the procedure was granted a limited humanitarian device exemption by the FDA in 2009. In this article, the authors review the development of DBS for OCD, describe the current understanding of the pathophysiological mechanisms of the disorder and how the underlying neural circuits might be modulated by DBS, and discuss the clinical studies that provide evidence for the use of this evolving therapy. The authors conclude with suggestions for how a combined basic science and translational research approach could drive the understanding of the neural mechanisms underlying OCD as well as the clinical effectiveness of DBS in the setting of recalcitrant disease.

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Section: Historical Perspectivementioning

confidence: 99%

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Mian

Campos

Sheth

et al. 2010

FOC

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“…LL most likely was the most effective treatment for depression during the lesion era. The method, introduced in 1973 by Kelly and Richardson (Mitchell-Heggs et al, 1976;Kelly et al, 1973), was based on the possibility that a dual lesion technique should produce better functional results compared with either single-lesion method alone. Our connectivity analysis demarcated the influenced tracts to the medial frontal, orbitofrontal, frontal polar, and subcallosal cortex.…”

Section: Discussionmentioning

confidence: 99%

“…(iv) Stereotactic limbic leucotomy (LL) is a combination of both bilateral ACT and SCT (Richardson, 1973). In diverse studies, rates of improvement of 50% (Mitchell-Heggs et al, 1976, Kim et al, 2002 to 78% (Cosgrove and Rauch, 2003;Montoya et al, 2002) have been reported (Mitchell-Heggs et al, 1976;Kim et al, 2002;Kelly et al, 1973;Diering and Bell, 1991). Thus, LL stands out as the clinically most effective lesioning procedure for depression.…”

Section: Introductionmentioning

confidence: 99%

Tractographic Analysis of Historical Lesion Surgery for Depression

Schoene-Bake

Parpaley

Weber

et al. 2010

Neuropsychopharmacol

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Various surgical brain ablation procedures for the treatment of refractory depression were developed in the twentieth century. Most notably, key target sites were (i) the anterior cingulum, (ii) the anterior limb of the internal capsule, and (iii) the subcaudate white matter, which were regarded as effective targets. Long-term symptom remissions were better following lesions of the anterior internal capsule and subcaudate white matter than of the cingulum. It is possible that the observed clinical improvements of these various surgical procedures may reflect shared influences on presently unspecified brain affect-regulating networks. Such possibilities can now be analyzed using modern brain connectivity procedures such as diffusion tensor imaging (DTI) tractography. We determined whether the shared connectivities of the above lesion sites in healthy volunteers might explain the therapeutic effects of the various surgical approaches. Accordingly, modestly sized historical lesions, especially of the anatomical overlap areas, were 'implanted' in brain-MRI scans of 53 healthy subjects. These were entered as seed regions for probabilistic DTI connectivity reconstructions. We analyzed for the shared connectivities of bilateral anterior capsulotomy, anterior cingulotomy, subcaudate tractotomy, and stereotactic limbic leucotomy (a combination of the last two lesion sites). Shared connectivities between the four surgical approaches mapped onto the most mediobasal aspects of bilateral frontal lobe fibers, including the forceps minor and the anterior thalamic radiations that contacted subgenual cingulate regions. Anatomically, convergence of these shared connectivities may derive from the superolateral branch of the medial forebrain bundle (MFB), a structure that connects these frontal areas to the origin of the mesolimbic dopaminergic 'reward' system in the midbrain ventral tegmental area. Thus, all four surgical anti-depressant approaches may be promoting positive affect by converging influences onto the MFB.

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“…Para ello, hay que implantar un marco metálico en la cabeza del paciente, en el cual existen unas coordenadas tridimensionales externas, que detallan de forma muy precisa su correspondencia con estructuras internas cerebrales. El desarrollo de las técnicas estereotáxicas ha supuesto un avance importante en la neurocirugía funcional (29,37,38).…”

Section: Ablación Estereotáxicaunclassified

Tratamiento quirúrgico de la anorexia nerviosa resistente al tratamiento médico

et al. 2016

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Palabras clave:Anorexia nerviosa. Estimulación cerebral profunda. Psicocirugía. Neuroestimulación. Key words:Anorexia nervosa. Deep brain stimulation. Psychosurgery. Neurostimulation. AbstractGiven the advances experienced in neurosurgical techniques, and because the diagnosis and classifi cation of psychiatric diseases has evolved over the past decades, new experimental treatments are arising to treat a greater number of medication-resistant psychiatric patients. Among psychiatric diseases, anorexia nervosa has the highest mortality rate, and approximately 20% of patients experience torpid outcomes. For these patients who do not respond to conservative management, deep brain stimulation has arisen as an alternative option, although studies are still scarce. We review the pathophysiology of anorexia nervosa, as well as the various neurosurgical treatments that have been performed throughout history. The prospect of current surgical treatments is detailed, as well as the ethical aspects to consider regarding the emergence of these new therapies. ResumenGracias a los avances en técnicas neuroquirúrgicas, y debido a que el diagnóstico y la clasifi cación de las enfermedades psiquiátricas han evolucionado signifi cativamente a lo largo de las últimas décadas, se están desarrollando tratamientos a nivel experimental para aquellos pacientes resistentes al manejo conservador. La anorexia nerviosa es una enfermedad de prevalencia creciente, con la tasa de mortalidad más elevada dentro de los trastornos psiquiátricos, y con aproximadamente un 20% de pacientes que presentan una evolución tórpida. Para estos pacientes que no responden a manejo conservador, la estimulación cerebral profunda ha surgido como una alternativa terapéutica, si bien la literatura especializada al respecto es escasa. A continuación presentamos una revisión de la fi siopatología de la anorexia nerviosa, así como de los distintos tratamientos neuroquirúrgicos realizados a lo largo de la historia. Se detalla la perspectiva de tratamiento quirúrgico actual, así como los aspectos éticos que se han de considerar en relación con el surgimiento de estas nuevas terapias.

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Stereotactic Limbic Leucotomy: A Preliminary Report on Forty Patients

Cited by 89 publications

References 14 publications

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Deep brain stimulation for obsessive-compulsive disorder: past, present, and future

Tractographic Analysis of Historical Lesion Surgery for Depression

Tratamiento quirúrgico de la anorexia nerviosa resistente al tratamiento médico

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