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Future of Neurosurgery

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Psychiatric Neurotherapeutics

Part of the book series: Current Clinical Psychiatry ((CCPSY))

Abstract

Stereotactic ablative procedures, including anterior capsulotomy, cingulotomy, subcaudate tractotomy, and limbic leucotomy, have provided an important therapeutic option for patients with treatment-resistant psychiatric disorders for over 50 years. Information obtained from the decades of experience with lesion-based therapies led to the application of deep brain stimulation (DBS) for psychiatric indications at the turn of the millennium. Several clinical trials have already demonstrated the efficacy of DBS for obsessive-compulsive disorder and major depressive disorder. Future advancements in this field will hinge upon (1) a better understanding of the neural circuitry underlying human cognition and emotion and the pathological processes contributing to its dysfunction and (2) the development of more precise methods of delivering neuromodulatory signals to the human brain. The first endeavor will involve a combination of behavioral, electrophysiological, and neuroimaging investigations across a range of species, including rodent, nonhuman primate, and human, each targeted toward the strengths of the particular model. The second will require new collaborative efforts between basic scientists and clinicians to translate delivery methods on the horizon, including optogenetics, closed-loop stimulators, and gene therapy, into viable treatments. These advances will hopefully enable individualization of therapy based on identifiable patient characteristics and biomarkers, thereby potentially increasing efficacy and decreasing side effects. The judicious application of these develo** procedures, with appropriate oversight by a multidisciplinary team, will ensure that an expanding cohort of patients with debilitating psychiatric illness will have a viable and safe therapeutic option.

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References

  1. Moniz E. Prefrontal leucotomy in the treatment of mental disorders. Am J Psychiatry. 1937;93:1379–85.

    Article  Google Scholar 

  2. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand. 1951;102(4):316–9.

    CAS  PubMed  Google Scholar 

  3. Binder DK, Iskandar BJ. Modern neurosurgery for psychiatric disorders. Neurosurgery. 2000;47(1):9–21.

    CAS  PubMed  Google Scholar 

  4. Nuttin B, Cosyns P, Demeulemeester H, Gybels J, Meyerson B. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999;354:1526.

    Article  CAS  PubMed  Google Scholar 

  5. Nuttin BJ, Gabriels LA, Cosyns PR, et al. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery. 2003;52(6):1263–72.

    Article  PubMed  Google Scholar 

  6. Malone Jr DA, Dougherty DD, Rezai AR, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009;65(4):267–75.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Mallet L, Mesnage V, Houeto JL, et al. Compulsions, Parkinson’s disease, and stimulation. Lancet. 2002;360(9342):1302–4.

    Article  PubMed  Google Scholar 

  8. Mallet L, Polosan M, Jaafari N, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008;359(20):2121–34.

    Article  CAS  PubMed  Google Scholar 

  9. Ballantine Jr HT, Cassidy WL, Flanagan NB, Marino Jr R. Stereotaxic anterior cingulotomy for neuropsychiatric illness and intractable pain. J Neurosurg. 1967;26(5):488–95.

    Article  PubMed  Google Scholar 

  10. Whitty CW, Duffield JE, Tov PM, Cairns H. Anterior cingulectomy in the treatment of mental disease. Lancet. 1952;1(6706):475–81.

    Article  CAS  PubMed  Google Scholar 

  11. Milad MR, Quirk GJ. Neurons in medial prefrontal cortex signal memory for fear extinction. Nature. 2002;420(6911):70–4.

    Article  CAS  PubMed  Google Scholar 

  12. Milad MR, Vidal-Gonzalez I, Quirk GJ. Electrical stimulation of medial prefrontal cortex reduces conditioned fear in a temporally specific manner. Behav Neurosci. 2004;118(2):389–94.

    Article  CAS  PubMed  Google Scholar 

  13. Baeg EH, Kim YB, Jang J, Kim HT, Mook-Jung I, Jung MW. Fast spiking and regular spiking neural correlates of fear conditioning in the medial prefrontal cortex of the rat. Cereb Cortex. 2001;11(5):441–51.

    Article  CAS  PubMed  Google Scholar 

  14. Gilmartin MR, McEchron MD. Single neurons in the medial prefrontal cortex of the rat exhibit tonic and phasic coding during trace fear conditioning. Behav Neurosci. 2005;119(6):1496–510.

    Article  PubMed  Google Scholar 

  15. Vidal-Gonzalez I, Vidal-Gonzalez B, Rauch SL, Quirk GJ. Microstimulation reveals opposing influences of prelimbic and infralimbic cortex on the expression of conditioned fear. Learn Mem. 2006;13(6):728–33.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Livet J, Weissman TA, Kang H, et al. Transgenic strategies for combinatorial expression of fluorescent proteins in the nervous system. Nature. 2007;450(7166):56–62.

    Article  CAS  PubMed  Google Scholar 

  17. Phillips ML, Marks IM, Senior C, et al. A differential neural response in obsessive-compulsive disorder patients with washing compared with checking symptoms to disgust. Psychol Med. 2000;30(5):1037–50.

    Article  CAS  PubMed  Google Scholar 

  18. Greenberg BD, Rauch SL, Haber SN. Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology. 2010;35(1):317–36.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, Speckens A, Phillips ML. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004;61(6):564–76.

    Article  PubMed  Google Scholar 

  20. Abramowitz JS. The psychological treatment of obsessive-compulsive disorder. Can J Psychiatry. 2006;51(7):407–16.

    PubMed  Google Scholar 

  21. Mayberg HS, Liotti M, Brannan SK, et al. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. 1999;156(5):675–82.

    CAS  PubMed  Google Scholar 

  22. Mayberg HS, Lozano AM, Voon V, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45(5):651–60.

    Article  CAS  PubMed  Google Scholar 

  23. Amirnovin R, Williams ZM, Cosgrove GR, Eskandar EN. Visually guided movements suppress subthalamic oscillations in Parkinson's disease patients. J Neurosci. 2004;24(50):11302–6.

    Article  CAS  PubMed  Google Scholar 

  24. Carlson JD, Cleary DR, Cetas JS, Heinricher MM, Burchiel KJ. Deep brain stimulation does not silence neurons in subthalamic nucleus in Parkinson's patients. J Neurophysiol. 2010;103(2):962–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Montgomery Jr EB. Effects of GPi stimulation on human thalamic neuronal activity. Clin Neurophysiol. 2006;117(12):2691–702.

    Article  PubMed  Google Scholar 

  26. Dostrovsky JO, Levy R, Wu JP, Hutchison WD, Tasker RR, Lozano AM. Microstimulation-induced inhibition of neuronal firing in human globus pallidus. J Neurophysiol. 2000;84(1):570–4.

    CAS  PubMed  Google Scholar 

  27. Zaghloul KA, Blanco JA, Weidemann CT, et al. Human substantia nigra neurons encode unexpected financial rewards. Science. 2009;323(5920):1496–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Goodman WK, Foote KD, Greenberg BD, et al. Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design. Biol Psychiatry. 2010;67(6):535–42.

    Article  PubMed  Google Scholar 

  29. Greenberg BD, Gabriels LA, Malone Jr DA, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2010;15(1):64–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Deisseroth K, Feng G, Majewska AK, Miesenbock G, Ting A, Schnitzer MJ. Next-generation optical technologies for illuminating genetically targeted brain circuits. J Neurosci. 2006;26(41):10380–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Zhang F, Aravanis AM, Adamantidis A, de Lecea L, Deisseroth K. Circuit-breakers: optical technologies for probing neural signals and systems. Nat Rev Neurosci. 2007;8(8):577–81.

    Article  CAS  PubMed  Google Scholar 

  32. Tsai HC, Zhang F, Adamantidis A, et al. Phasic firing in dopaminergic neurons is sufficient for behavioral conditioning. Science. 2009;324(5930):1080–4.

    Article  CAS  PubMed  Google Scholar 

  33. Billiet E, Richter M, Kennedy J. Genetics of obsessive-compulsive disorder. In: Swinson R, Antony M, Rachman S, Richter M, editors. Obsessive–compulsive disorder. Theory, research, and treatment. New York: Guilford Press; 1998. p. 181–206.

    Google Scholar 

  34. Edvardsen J, Torgersen S, Roysamb E, et al. Unipolar depressive disorders have a common genotype. J Affect Disord. 2009;117(1–2):30–41.

    Article  PubMed  Google Scholar 

  35. Davis JO, Phelps JA, Bracha HS. Prenatal development of monozygotic twins and concordance for schizophrenia. Schizophr Bull. 1995;21(3):357–66.

    Article  CAS  PubMed  Google Scholar 

  36. Lopez-Leon S, Janssens AC, Gonzalez-Zuloeta Ladd AM, et al. Meta-analyses of genetic studies on major depressive disorder. Mol Psychiatry. 2008;13(8):772–85.

    Article  CAS  PubMed  Google Scholar 

  37. Denys D, Van Nieuwerburgh F, Deforce D, Westenberg HG. Association between serotonergic candidate genes and specific phenotypes of obsessive compulsive disorder. J Affect Disord. 2006;91(1):39–44.

    Article  CAS  PubMed  Google Scholar 

  38. Aouizerate B, Guehl D, Cuny E, et al. Pathophysiology of obsessive-compulsive disorder: a necessary link between phenomenology, neuropsychology, imagery and physiology. Prog Neurobiol. 2004;72(3):195–221.

    Article  PubMed  Google Scholar 

  39. Spellmann I, Rujescu D, Musil R, et al. Homer- polymorphisms are associated with psychopathology and response to treatment in schizophrenic patients. J Psychiatr Res. 2011;45:234–41.

    Article  PubMed  Google Scholar 

  40. Welch JM, Lu J, Rodriguiz RM, et al. Cortico-striatal synaptic defects and OCD-like behaviours in Sapap3-mutant mice. Nature. 2007;448(7156):894–900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Sun FT, Morrell MJ, Wharen Jr RE. Responsive cortical stimulation for the treatment of epilepsy. Neurotherapeutics. 2008;5(1):68–74.

    Article  PubMed  Google Scholar 

  42. Sun D, van Erp TG, Thompson PM, et al. Elucidating a magnetic resonance imaging-based neuroanatomic biomarker for psychosis: classification analysis using probabilistic brain atlas and machine learning algorithms. Biol Psychiatry. 2009;66(11):1055–60.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Hamilton LS, Altshuler LL, Townsend J, et al. Alterations in functional activation in euthymic bipolar disorder and schizophrenia during a working memory task. Hum Brain Mapp. 2009;30(12):3958–69.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Report and Recommendations—Psychosurgery. The National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. Vol DHEW Pub. No. (OS)77-0001. Washington, DC: U.S. Government Printing Office; 1977.

    Google Scholar 

  45. Cosgrove GR, Rauch SL. Stereotactic cingulotomy. Neurosurg Clin N Am. 2003;14(2):225–35.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA

    Sameer A. Sheth M.D., Ph.D.

  2. Harvard Medical School, Boston, MA, USA

    Polina Ogas

  3. Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., White 502, Boston, MA, 02114, USA

    Emad N. Eskandar M.D.

Authors
  1. Sameer A. Sheth M.D., Ph.D.
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  2. Polina Ogas
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  3. Emad N. Eskandar M.D.
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Corresponding author

Correspondence to Emad N. Eskandar M.D. .

Editor information

Editors and Affiliations

  1. Medical School, Dept of Psychiatry, Massachusetts Gen Hosp, Harvard, Boston, Massachusetts, USA

    Joan A. Camprodon

  2. McLean Hospital, Belmont, Massachusetts, USA

    Scott L. Rauch

  3. Butler Hospital, Providence, Rhode Island, USA

    Benjamin D. Greenberg

  4. Harvard Medical School, Charleston, Massachusetts, USA

    Darin D. Dougherty

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Sheth, S.A., Ogas, P., Eskandar, E.N. (2016). Future of Neurosurgery. In: Camprodon, J., Rauch, S., Greenberg, B., Dougherty, D. (eds) Psychiatric Neurotherapeutics. Current Clinical Psychiatry. Humana Press, New York, NY. https://doi.org/10.1007/978-1-59745-495-7_10

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  • DOI: https://doi.org/10.1007/978-1-59745-495-7_10

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  • Publisher Name: Humana Press, New York, NY

  • Print ISBN: 978-1-934115-50-3

  • Online ISBN: 978-1-59745-495-7

  • eBook Packages: MedicineMedicine (R0)

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