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Author Notes:

Correspondence to: Dr Bart Nuttin, Department of Neurosurgery, UZ Leuven, KU Leuven, Herestraat 49, 3000 Leuven Belgium; bart.nuttin@kuleuven.be

See publication for full list of author contributions.

Joseph J Fins, M.D., M.A.C.P., Chief of the Division of Medical Ethics of Weill Medical College of Cornell University and member of the Europäische Akademie's Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’ made co-first author contributions to this paper and agreed with its conclusions.

Professor Fins has declined to be listed as an author.

We thank Damianos Sakas, Jairo Espinoza, Marcos Baabor, Fabián Piedimonte, Terry Coyne and Takamitsu Yamamoto for their critical comments and final approval of the manuscript.

See publication for full list of disclosures.

Subject:

Research Funding:

The Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’ was funded by the Volkswagen Foundation (Hanover, Germany).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Clinical Neurology
  • Psychiatry
  • Surgery
  • Neurosciences & Neurology
  • DEEP BRAIN-STIMULATION
  • ETHICAL CONDUCT
  • NEUROMODULATION
  • RECOMMENDATIONS
  • PSYCHOSURGERY

Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

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Journal Title:

Journal of Neurology, Neurosurgery and Psychiatry

Volume:

Volume 85, Number 9

Publisher:

, Pages 1003-1008

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

© 2017 by the BMJ Publishing Group Ltd. All rights reserved.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 3.0 Unported License (http://creativecommons.org/licenses/by/3.0/).

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