Current status of neurosurgery for psychiatric disorders in the world

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  • Taira Takaomi
    Department of Neurosurgery, Tokyo Women’s Medical University

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  • 海外における精神疾患に対する脳神経外科治療の現状
  • カイガイ ニ オケル セイシン シッカン ニ タイスル ノウ シンケイ ゲカ チリョウ ノ ゲンジョウ

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Abstract

As the president of the World Society for Stereotactic and Functional Neurosurgery where majority of neurosurgeons performing operations for psychiatric disorders are involved, I introduce current consensus, issues to be solved, and situations of neurosurgery for psychiatric disorders (NPD in the world. WSSFN regards NPD as research stage treatment and it is not yet an established clinical practice. This means that there should be a strict well-designed protocol, IRB approval, audit and monitoring committees, and consent by the patient. These are the minimal requirement, and NPD must aim at treatment or relief of suffering in patients with psychiatric disorders. The difference between “clinical research” and “clinical practice” should be made clear to the patients, family, and the society. Deep brain stimulation (DBS) is the most preferred method of intervention, because this is less destructive, reversible, and well accepted as a treatment of intractable movement disorders. The most common subjects of NPD are intractable obsessive compulsive disorder (OCD) and treatment - resistant depression (TRD), while other conditions such as Alzheimer disease, anorexia, drug addiction and aggressiveness are investigated. There is, however, no unanimous agreement about the best location of deep brain stimulation in the brain. There are many targets of DBS proposed and investigated, and majority of them seem to be related with the medial forebrain bundle. Considering the intractability of severe OCD and TRD that are refractory to other treatments, the results of DBS for NPD seem promising and feasible to promote further large- scale studies. Japan alone can no longer be isolated from this field of neuroscience.

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