Document Detail


Magnetic resonance imaging-guided stereotactic limbic leukotomy for treatment of intractable psychiatric disease.
MedLine Citation:
PMID:  11950407     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To assess the efficacy and complication rates of magnetic resonance imaging-guided stereotactic limbic leukotomy for the treatment of intractable major depressive disorder (MDD) and obsessive-compulsive disorder (OCD). METHODS: We conducted preoperative evaluations and postoperative follow-up assessments of efficacy and complications for 21 patients who underwent limbic leukotomy. Efficacy was based on physician- and patient-rated global assessments of functioning, as well as evaluations using disease-specific rating scales commonly used in studies of MDD and OCD. RESULTS: The mean time from limbic leukotomy to follow-up assessment was 26 months. On the basis of standard outcome measures, 36 to 50% of patients were considered to be treatment responders. Although permanent surgical morbidity was rare, there were reports of postoperative sequelae, including apathy, urinary incontinence, and memory complaints, which occurred in a substantial minority of cases. CONCLUSION: For this cohort of 21 patients with chronic severe MDD or OCD, who had experienced failure with an exhaustive array of previous treatments, limbic leukotomy was associated with substantial benefit for 36 to 50%. This rate is comparable to those of previous studies of limbic system surgery and indicates that limbic leukotomy is a feasible treatment option for severe, treatment-refractory MDD or OCD. Adverse consequences associated with the procedure included affective, cognitive, and visceromotor sequelae, which were generally transient.
Authors:
Alonso Montoya; Anthony P Weiss; Bruce H Price; Edwin H Cassem; Darin D Dougherty; Andrew A Nierenberg; Scott L Rauch; G Rees Cosgrove
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  50     ISSN:  0148-396X     ISO Abbreviation:  Neurosurgery     Publication Date:  2002 May 
Date Detail:
Created Date:  2002-04-12     Completed Date:  2002-06-28     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1043-9; discussion 1049-52     Citation Subset:  IM    
Affiliation:
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cohort Studies
Depressive Disorder, Major / psychology,  surgery*
Feasibility Studies
Female
Follow-Up Studies
Humans
Limbic System / surgery*
Magnetic Resonance Imaging*
Male
Memory Disorders / etiology
Middle Aged
Mood Disorders / etiology
Obsessive-Compulsive Disorder / psychology,  surgery*
Psychosurgery* / adverse effects
Stereotaxic Techniques*
Surgery, Computer-Assisted*
Time Factors
Urinary Incontinence / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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