Stereotaxic Amygdalotomy for Behavior Disorders

Narabayashi, Hirotaro; Nagao, Takeki; Saito, Yoshiaki; Yoshida, M; Nagahata, Masamichi

doi:10.1001/archneur.1963.00460070011001

Cited by 211 publications

(89 citation statements)

References 10 publications

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“…More than 1000 patients eventually received the procedure, with approximately 75% of these patients displaying no further aggressive behavior. 171,201,204,205 Side effects of the procedure included reduced autonomic response to stressful cues, new-onset epilepsy, and hypersexual behavior, but overall these were limited to a small number of patients. Despite the high success rate of the surgery, subsequent public backlash against psychosurgery led to widely preferential use of pharmacological agents for behavioral control.…”

Section: Aggressive Behaviormentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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Fossil records showing trephination in the Stone Age provide evidence that humans have sought to influence the mind through physical means since before the historical record. Attempts to treat psychiatric disease via neurosurgical means in the 20th century provided some intriguing initial results. However, the indiscriminate application of these treatments, lack of rigorous evaluation of the results, and the side effects of ablative, irreversible procedures resulted in a backlash against brain surgery for psychiatric disorders that continues to this day. With the advent of psychotropic medications, interest in invasive procedures for organic brain disease waned. Diagnosis and classification of psychiatric diseases has improved, due to a better understanding of psychiatric patho-physiology and the development of disease and treatment biomarkers. Meanwhile, a significant percentage of patients remain refractory to multiple modes of treatment, and psychiatric disease remains the number one cause of disability in the world. These data, along with the safe and efficacious application of deep brain stimulation (DBS) for movement disorders, in principle a reversible process, is rekindling interest in the surgical treatment of psychiatric disorders with stimulation of deep brain sites involved in emotional and behavioral circuitry. This review presents a brief history of psychosurgery and summarizes the development of DBS for psychiatric disease, reviewing the available evidence for the current application of DBS for disorders of the mind.

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Section: Aggressive Behaviormentioning

confidence: 99%

Deep brain stimulation for psychiatric disorders: where we are now

Cleary

Ozpinar

Raslan

et al. 2015

FOC

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“…Due to its well-defined involvement in emotion and aggression, the amygdala became the first major surgical target for aggressive disorder treatment. In 1963, Narabayashi et al 24 published the first large series of patients treated with amydalotomy for severe aggressive disorders, reporting that surgery reduced aggression and improved social behavior in 85% of the cases. More recently, Mpakopoulou et al 23 described historical and current perspectives on amygdalotomy.…”

Section: Surgical Approaches To Aggressive Disordersmentioning

confidence: 99%

Deep brain stimulation of the orbitofrontal projections for the treatment of intermittent explosive disorder

Maley¹,

Alvernia²,

Valle³

et al. 2010

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Intermittent explosive disorder (IED) is characterized by a dysfunction in the greater limbic system leading an individual to experience sudden aggressive behavior with little or no environmental perturbation. This report describes a procedure for the treatment of IED in a 19-year-old woman with a history of IED, having had episodes of severe violent attacks against family, dating to early childhood. Due to the severity and intractability of the illness, deep brain stimulation was performed, targeting the orbitofrontal projections to the hypothalamus. The patient's history and the procedure, management, and rationale are described in detail.

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“…The effectiveness of lesions in this region also became apparent as a spin-off of stereotactic amygdalar ablation for aggressive behaviour disorders in which many of the patients were also epileptic. 5 The rationale for ablation of medial temporal lobe structures (ie. amygdala, hippocampus) was based on the premise that even if these nuclei were not the actual epileptic focus, the spread of an epileptogenic d i s c h a rge from the temporal lobe was largely through the amygdala and hippocampus to the hypothalamus and thalamus.…”

Section: Historical Backgroundmentioning

confidence: 99%

“…5 While the aim of the surgery was control of the behaviour disorder, it was also found that seizures were improved in some patients. Of 25 patients, mainly children with predominantly grand mal seizures, nine became seizure-free (six free of medication) and seizures decreased in eight.…”

Section: Stereotactic Amygdalotomy Hippocampotomymentioning

confidence: 99%

Stereotactic Surgery for Temporal Lobe Epilepsy

Parrent

Lozano²

2000

Can J Neurol Sci.

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There has been a resurgence of interest in stereotactic procedures for epilepsy and functional neurosurgical disorders. There are several factors responsible for this. The most important is the significant improvement in brain imaging which has come as a consequence of the development of computerized tomography and, in particular, magnetic resonance imaging (MRI). T h e s e procedures have improved the spatial definition and resolution of imaging and have made image-guided surgery easier, more accurate and more accessible to mainstream neurosurg e r y. T h e improvements in imaging have worked in concert with an increased understanding of the pathophysiology of epilepsy disorders such that the identification and selection of targets has a stronger scientific rationale than was previously available. In addition to these important developments, there is a large historical basis for the use of stereotactic procedures in the treatment of epilepsy with some interesting if not promising initial results.Finally the general trend towards minimally invasive surgery is responsible for the need to re-examine stereotactic procedures. With the trend towards minimizing surgical exposure and patient discomfort and shortening hospital stay, there will be a further need to re-examine the use of stereotactic functional procedures. ABSTRACT:In light of the recent resurgence of interest in stereotactic functional procedures, the authors have reviewed the role of stereotactic ablative surgery in the treatment of temporal lobe epilepsy. Literature pertaining to stereotactic amygdalotomy, hippocampotomy and fornicotomy is reviewed and summarized. However, the results presented in those early studies are difficult to interpret given the surgical techniques and outcome assessment used. Modern stereotactic ablative surgery using current image-guided technology offers the opportunity to revisit some of these techniques. In recent studies of stereotactic amygdalohippocampotomy, outcomes are not as favorable as those obtained with standard temporal resections. However, these relatively discrete ablative techniques may shed light on the anatomical substrate underlying temporal lobe epilepsy.RÉSUMÉ: La chirurgie stéréotaxique dans l'épilepsie temporale. Dans l'optique d'un regain récent d'intérêt pour les procédures fonctionnelles stéréotaxiques, les auteurs ont revu le rôle de la chirurgie ablative stéréotaxique dans le traitement de l'épilepsie temporale. La littérature concernant l'amygdalotomie stéréotaxique, l'hippocampotomie et la fornicotomie est revue et résumée. Cependant, les résultats présentés dans les études antérieures sont difficiles à interpréter compte tenu des techniques chirurgicales et des moyens d'évaluation des résultats utilisés. La chirurgie ablative stéréotaxique moderne utilisant la technologie sous guidage par imagerie offre l'occasion de revoir certaines de ces techniques. Dans les études récentes de l'amygdalohippocampotomie stéréotaxique, les résultats ne sont pas aussi favorables que ceux obtenus par les résecti...

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Stereotaxic Amygdalotomy for Behavior Disorders

Cited by 211 publications

References 10 publications

Deep brain stimulation for psychiatric disorders: where we are now

Deep brain stimulation for psychiatric disorders: where we are now

Deep brain stimulation of the orbitofrontal projections for the treatment of intermittent explosive disorder

Stereotactic Surgery for Temporal Lobe Epilepsy

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