Stereotaxic Anterior Cingulotomy for Neuropsychiatric Illness and Intractable Pain

Ht, Ballantine; Wl, Cassidy; Nb, Flanagan; Marino, Raul

doi:10.3171/jns.1967.26.5.0488

Cited by 348 publications

(133 citation statements)

References 12 publications

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“…3A). The perceived unpleasantness of a painful stimulus is correlated to the activity in the ACC (Rainville et al, 1997) which is in line with ®ndings that lesions in the human ACC may reduce the affective response of chronic ongoing pain (Ballantine et al, 1967;Vogt et al, 1993). The subjects rated the unpleasantness in painful stimulation less during simultaneous solving of the maze task.…”

Section: Interactionssupporting

confidence: 56%

Pain-related cerebral activation is altered by a distracting cognitive task

Petrović

Petersson

Ghatan

et al. 2000

Pain

380

224

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It has previously been suggested that the activity in sensory regions of the brain can be modulated by attentional mechanisms during parallel cognitive processing. To investigate whether such attention-related modulations are present in the processing of pain, the regional cerebral blood¯ow was measured using [15 O]butanol and positron emission tomography in conditions involving both pain and parallel cognitive demands. The painful stimulus consisted of the standard cold pressor test and the cognitive task was a computerised perceptual maze test. The activations during the maze test reproduced ®ndings in previous studies of the same cognitive task. The cold pressor test evoked signi®cant activity in the contralateral S1, and bilaterally in the somatosensory association areas (including S2), the ACC and the mid-insula. The activity in the somatosensory association areas and periaqueductal gray/midbrain were signi®cantly modi®ed, i.e. relatively decreased, when the subjects also were performing the maze task. The altered activity was accompanied with signi®cantly lower ratings of pain during the cognitive task. In contrast, lateral orbitofrontal regions showed a relative increase of activity during pain combined with the maze task as compared to only pain, which suggests the possibility of the involvement of frontal cortex in modulation of regions processing pain.

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Section: Interactionssupporting

confidence: 56%

Pain-related cerebral activation is altered by a distracting cognitive task

Petrović

Petersson

Ghatan

et al. 2000

Pain

380

224

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“…These B A beta (13-30 Hz) alpha (7-13 Hz) theta (4-7 Hz) theta (4-7 Hz) Fig. 6 Pre-surgery whole brain correlation analysis between the factors pain intensity (a) or frustration (b) and LORETA EEG activity averaged for the HPR and LPR groups results are in line with the well-known central role of cingulate and PFC areas during experimental pain and NP (Apkarian et al 2001(Apkarian et al , 2005Baliki et al 2006;Ballantine et al 1967;Dube, et al 2009;Hsieh et al 1995;Jones et al 2003a;Ploner et al 2002;Salomons et al 2007;Sarnthein et al 2006;Starr et al 2009;Stern et al 2006;Treede et al 1999Treede et al , 2003Wager et al 2004;Willoch et al 2000). It is also known that the unpleasantness of pain activates the cingulate and PFC (Mobascher et al 2009), amygdala, and insula (Brooks et al 2005), although all of these studies examined exogenously induced pain (e.g., induced by painful stimulation) rather than chronic NP.…”

Section: Preoperative Observationssupporting

confidence: 81%

“…The key structure of the medial pain system is the ACC, which is a functionally heterogeneous brain area that receives its main afferents from the medial thalamic nuclei and which has been implicated in the integration of cognition, affect and social behaviour (Devinsky et al 1995). The largest evidence for the coupling of cingulate areas and pain processing came from lesion and stimulation studies (Ballantine et al 1967;Spooner et al 2007). Specifically, it has been shown that cingulotomy provides significant PR in half to three quarters of pain patients (Ballantine et al 1967).…”

Section: Preoperative Observationsmentioning

confidence: 99%

Correlations between EEG and clinical outcome in chronic neuropathic pain: surgical effects and treatment resistance

Michels

Moazami-Goudarzi

Jeanmonod

2011

Brain Imaging and Behavior

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Chronic neuropathic pain may require a neurosurgical treatment, but for reasons that have not been fully explored yet, a significant number of patients do not benefit from the intervention. We compared the resting EEG of 15 healthy controls to the EEG of 23 chronic neuropathic pain patients before and 12 months after treatment by the central lateral thalamotomy (CLT). A patient subgroup had a high (n=14, pain relief (PR)≥50%) and another subgroup a low (n=9, PR<50%) postoperative PR. EEG spectral power and source localization of the high PR patients were normalized postoperatively. In contrast, low PR patients showed postoperative maintenance of insular, cingulate and prefrontal overactivities, and their frustration values were positively correlated with cingulate and prefrontal activity. These findings demonstrate a normalizing effect of CLT on cortical activity and suggest that treatment resistance is associated with a frustration-based dynamics.

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“…Around the same time, the cingulotomy procedure was developed to target the ACC and underlying cingulum bundle. 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.…”

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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Stereotaxic Anterior Cingulotomy for Neuropsychiatric Illness and Intractable Pain

Cited by 348 publications

References 12 publications

Pain-related cerebral activation is altered by a distracting cognitive task

Pain-related cerebral activation is altered by a distracting cognitive task

Correlations between EEG and clinical outcome in chronic neuropathic pain: surgical effects and treatment resistance

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

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