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psychosurgery:A History from Prefrontal Lobotomy to Deep Brain Stimulation

Journal of Geriatric Medicine 2019年第3期1卷 1-8页

作者： Aisha Yousaf Krishna Singh Victoria Tavernor Ashley Baldwin Departments of Psychiatry Rydal WardKnowsley Resource and Recovery CentreNorth West Boroughs Healthcare NHS Foundation TrustKnowsleyMerseysideUnited Kingdom Christ’s College Cambridge UniversityCambridgeshir

Neurosurgical treatment for psychiatric disorders features a long and controversial *** article explores a“spectrum of psychosurgery”,describing how old-fashioned and controversial prefrontal lobotomy gradually evolved into modern day,mainstream scientific deep brain stimulation(DBS).We focus on the rise,fall and possible re-emergence of psychosurgery as a therapeutic intervention *** journey through historic indiscriminate use of prefrontal lobotomy,which evoked stern criticism from both public and professionals,through to the development of modern day DBS-performed for patients suffering from severe,treatment resistant symptoms of obsessive-compulsive disorder(OCD),epilepsy and movement *** hope this article will provide a basis for understanding the availability of existing treatment options and potential future opportunities,whilst simultaneously challenging any public/professional preconceptions of psychosurgery,which may indirectly be obstructing patient ***,we carried out a qualitative survey displayed in WordCloud Format,capturing the intellection of 38 mental health professionals working for North West Boroughs NHS Healthcare Foundation Trust,on“psychosurgery”,“prefrontal lobotomy”and“DBS”,which may well reflect wider public *** summary,the article provides a brief,yet comprehensive overview of the controversial history of psychosurgery,present-day practice,and future trends of neurosurgery for psychiatric disorders.

关键词： psychosurgery Prefrontal lobotomy Deep brain stimulation Obsessive compulsive disorder Tourette syndrome Epilepsy Parkinson's Disease One flew over the cuckoo's nest

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Neurosurgical treatment for addiction: lessons from an untold story in China and a path forward

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National Science Review 2020年第3期7卷 702-712页

作者： Shuo Ma Chencheng Zhang Ti-fei Yuan Douglas Steele Valerie Voon Bomin Sun Department of Functional Neurosurgery Ruijin Hospital Shanghai Jiao Tong University School of Medicine Shanghai Key Laboratory of Psychotic Disorders Shanghai Mental Health CenterShanghai Jiao Tong University School of Medicine Co-innovation Center of Neuroregeneration Nantong University Division of Imaging Science and Technology Medical School University of Dundee Department of Psychiatry University of Cambridge

Addiction is a major public-health crisis associated with significant disability and mortality. Although various pharmacological and behavioral treatments are currently available, the clinical efficacy of these treatments is limited. Given this situation, there is a growing interest in finding an effective neurosurgical treatment for addiction. First, we discuss the use of ablative surgery in treating addiction. We focus on the rise and fall of nucleus accumbens ablation for addiction in China. Subsequently, we review recent studies that have explored the efficacy and safety of deep-brain-stimulation treatment for addiction. We conclude that neurosurgical procedures, particularly deep-brain stimulation, have a potentially valuable role in the management of otherwise intractable addictive disorders. Larger well-controlled clinical trials, however, are needed to assess clinical efficacy and safety. We end by discussing several key issues involved in this clinical field and identifying some areas of progress.

关键词： drug addiction psychosurgery ablative surgery deep-brain stimulation medical ethics

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Intracerebral Microdialysis in Neurosurgery for Obsessive-Compulsive Disorder: Report of 2 Preliminary Cases

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Open Journal of Modern Neurosurgery 2020年第3期10卷 371-381页

作者： Sergio A. Sacchettoni Rafael Galera Juan F. Del Corral Juan P. Abud Aníbal Pinero Luis Teneud Napoleón Torres Rafael Rojas Pedro Rada Félix Guerrero Edgar González Mónica Bifano Dely Yazawa Luis Hernández Hospital and School of Medicine JM Vargas Universidad Central de Venezuela Caracas Venezuela Centro Medico-Docente La Trinidad Caracas Venezuela Neurology Mobile System Associates Miami FL USA Laboratory of Physiology of Behavior Universidad de Los Andes Mérida Venezuela University of Grenoble-Alpes CEA LETI Clinatec France

Neurosurgery for psychiatric disorders, notably for obsessive-compulsive disorder (OCD), was initiated in Venezuela in the decade of 1970, and consisted since that time in the classic stereotactic anterior cingulotomy. In order to know further about the physiopathology of this disorder, we performed intracerebral microdialysis in 2 patients who were operated on. The aim was to measure changes in extracellular neurotransmitters within the basal ganglia. The microdialysis probes were stereotactically placed in the right caudate nucleus and in the dorsomedial nucleus of the right thalamus. The microdialysis was done before the left cingulotomy, during the pause and after the right cingulotomy. Glutamate and gamma-aminobutyric acid (GABA) changes were similar in the caudate nucleus of both patients, whereas in the dorsomedial nucleus the changes were opposite among the 2 patients. Although this study does not bring enough data to explain such differences yet, the existence of dynamic changes in the neurochemistry of the basal ganglia during cingulotomy shows that intracerebral microdialysis can help in the understanding of the pathophysiology of OCD and eventually in the design of new surgeries with better results.

关键词： Psychiatric Neurosurgery psychosurgery Obsessive-Compulsive Disorder Intracerebral Microdialysis

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