Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

• Type of Material: Article
• Authors: Bart Nuttin, Katholieke University Leuven; Hemmings Wu, Katholieke University Leuven; Helen Mayberg, Emory University; Marwan Hariz, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Loes Gabriels, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Thorsten Galert, Deutsches Referenzzentrum für Ethik in den Biowissenschaften; Reinhard Merkel, University of Hamburg; Cynthia Kubu, Cleveland Clinic; Osvaldo Vilela-Filho, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Keith Matthews, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Takaomi Taira, Tokyo Women's Medical University; Andres M Lozano, Toronto Western Hospital; Gaston Schechtmann, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Paresh Doshi, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Giovanni Broggi, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Jean Regis, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Ahmed Alkhani, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Bomin Sun, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Sam Eljamel, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Michael Schulder, North Shore University Hospital; Michael Kaplitt, Weill Cornell Medical College; Emad Eskandar, Harvard Medical School; Ali Rezai, Ohio State University; Joachim K Krauss, Medical University of Hannover; Paulien Hilven, Katholieke University Leuven; Rick Schuurman, Academic Medical Center, Amsterdam; Pedro Ruiz, Miami Miller School of Medicine; Jin Woo Chang, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Paul Cosyns, Committee of Neurosurgery for Psychiatric Disorders; Nir Lipsman, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Juergen Voges, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Rees Cosgrove, WSSFN Committee on Neurosurgery for Psychiatric Disorders; Yongjie Li, Xuanwu Hospital; Thomas Schlaepfer, Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application
• Language: English
• Date: 2014-09-01
• Publisher: BMJ Publishing Group
• Publication Version: Final Published Version
• Copyright Statement: © 2017 by the BMJ Publishing Group Ltd. All rights reserved.
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1136/jnnp-2013-306580
• Title of Journal or Parent Work: Journal of Neurology, Neurosurgery and Psychiatry
• ISSN: 0022-3050
• Volume: 85
• Issue: 9
• Start Page: 1003
• End Page: 1008
• Grant/Funding Information: The Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’ was funded by the Volkswagen Foundation (Hanover, Germany).
• Keywords: DEEP BRAIN-STIMULATION; Psychiatry; NEUROMODULATION; Surgery; RECOMMENDATIONS; ETHICAL CONDUCT; PSYCHOSURGERY; Science & Technology; Clinical Neurology; Life Sciences & Biomedicine; Neurosciences & Neurology
• Research Categories: Biology, Neuroscience

Abstract

Background: For patients with psychiatric illnesses remaining refractory to 'standard' therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods: To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings: The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered 'established ' in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. Interpretation: This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety.