Introduction
Search strategy
Historical perspective
Electroconvulsive therapy
Vagus nerve stimulation
Transcranial magnetic stimulation
Lesion procedures
Lobotomy/leucotomy
Orbital and cortical undercutting
Cingulectomy (cingulotomy)
Subcaudate tractotomy
Limbic leucotomy
Other procedures
Author (year) | Number of patients | Outcome | Maximum follow-up | Complications | |
---|---|---|---|---|---|
Leucotomy/lobotomy | Freeman (1937) | 3 | Good results, patients back to normality | 6 weeks | Bleeding in 1 case |
Hutton (1941) | 2 | Moderate to high improvement | 1 month | Bet-wetting for months | |
Thorpe (1952) | 120 | 60.8% good result, 20.8% moderate, 18.3% not discharged or death, 6% readmission | 24 months | Mortality 3%, seizures 6%, personality changes, impairment of thinking/judgment | |
Robin (1958) | 43 | No improvement in general, only 15 patients showed certain kind of mild benefits | 19 years | 10 patients died, 9 within the first 6 months postsurgery | |
Elithorn (1959) | 65 | 57 patients improved, 10 remained unchanged, and none worsened (according physician), 62 glad, 13 neither glad nor sorry, and 1 regret (self-report elaborated by patients) | Not specified | Not mentioned | |
McKissock (1959) | 98 | 54% discharged and working, 23% discharged not working, 17% still admitted, and 5% died | Not specified | Mortality | |
Birley (1964) | 76 | 6% symptom-free, 43% much improved, 26% improved, 22% no improved, 1% worse | 10 years | 1 patient acute confusion, 1 unconscious for hours, 6 severe, and 17 slight personality changes | |
McKenzie (1964) | 27 | 22 patients discharged from clinic, no significant difference between surgery and controls | 5 years | Not mentioned | |
Kelly (1966) | 25 | 9 patients symptom-free, 8 much improved, 7 improved, 1 not improved, 0 worse | 6 weeks | Not mentioned | |
Post (1968) | 33 | 12 patients with good to moderate improvement, 21 patients with any improvement to poor outcome | 3 years | 1 death, 40% temporary psychiatric sequelae, 30% permanent changes, 28% disabling effect | |
Kelly (1972) | 15 | 3 patients symptom-free, 5 much improved, 3 improved, 4 not improved, 0 worse | 18 months | Aggressiveness 3%, minor changes 33%, weight gain 52%, no seizures | |
Winter (1972) | 3 | 2 patients with good outcome, 1 fair outcome | Not specified | Not mentioned | |
Smith (1977) | 17 | 5 patients symptom-free, 5 much improved, 6 improved, 1 not improved, 0 worse | 30 months | 3 cases of personality changes (2 disinhibition, 1 apathetic), 2 patients with seizures | |
Orbital and cortical undercutting | Scoville (1960) | 14 | 24% marked benefit or clinical cure, 28% significant benefit or marked benefit and clinical cure | 6.2 years | Mortality 2%, 3 blood clots, 29% one or more seizures, 5% seizures after more than 1 week |
Lewin (1961) | 29 | 12 patients greatly improved, 10 some benefit, 7 showed no improvement | 10 years | 8 transient incontinence, 3 weight gain, 5 seizures, disinhibition, euphoria | |
Knight (1964) | 221 | 91 no symptoms, 64 slight symptoms no treatment, 52 some symptoms requiring treatment, 11 unchanged, 3 deteriorated | Not specified | 1.2% mortality, 10% occasional seizures, 5% more than 1 attack despite drugs | |
Hirose (1965) | 6 | 1 markedly improved, 3 moderately improved, 2 symptom-free | 6.5 years | No mortality | |
Scoville (1977) | 17 | 9 cases excellent, 6 good, 2 died | Not specified | 4% mortality, 13% seizures, 1% minor stroke, 2% blood clot, 10% personality changes | |
Cingulectomy/cingulotomy | Whitty (1952) | 3 | 1 temporary improvement, 2 without changes | 2 years | 1 infection (death), weight gain 12 transient enuresis, 5 incontinences |
Le Beau (1954) | 9 | 3 good results with useful activity postsurgery | 3 years | 2 deaths, 2 transient hemiparesis, 1 intense anemia | |
Lewin (1961) | 5 | 1 greatly improved, 2 some benefit, 2 no improvement at all and died | 11 years | 1 local osteitis, 1 transient phase of high intracranial pressure | |
Cassidy (1965) | 15 | 7 patients good outcome, 6 improved, 2 no changes | 3 years | 1 suicide and 2 unsuccessful attempts | |
Ballantine (1967) | 26 | 75% improved importantly, 15% slightly improved, and 10% no improvement at all | Not specified | 3 cases seizures, 4 deaths (1 suicide) | |
Brown (1968) | 31 | 87% improved importantly, 4% improved, 4% slight improve, 4% did not improved, 1% worsened | 17 years | 1 major complication, one third transient urinary incontinence and euphoria | |
Bailey (1971) | 24 | 83% very good outcome, 8% remission, 8% marked improvement | Not specified | 4 cases infection, 2 seizures | |
Whitty (1972) | 2 | 1 patient improved but relapsed, 1 unchanged | 12 years | Loss of inhibition and concentration | |
Bailey (1973) | 71 | 51 patients with very good outcome, 15 with improvement, 4 slight improvement | 1 year | 1 death, personality changes, and motivational changes | |
Meyer (1973) | 22 | 2 cases very good improvement, 9 marked, 8 moderate, 1 slight, and 2 none | 4.5 years | 5 confusions, 2 seizures, 2 scalp infections, 1 temporary psychotic increase, 2 suicides | |
Bailey (1977) | 50 | 35 patients with very good outcome, 9 improved, 4 slight improvement, 1 unchanged | 13 years | 0.5% deaths, 7.5% reoperated, 2% suicide | |
Teuber (1977) | 7 | 5 patients with full or partial relief | Not specified | Less concentration | |
Vikki (1977) | 3 | 2 cases improved slightly, 1 unchanged | Not specified | Indifference and lack of judgment, initiative, and self-criticism | |
Martin (1977) | 31 | 14 cases excellent, 7 moderate, 4 slight, 6 none | 4 years | 2 subdural hematomas, 2 scalp infections | |
Corkin (1980) | 7 | 3 marked improvements, and 2 moderate | 2 years | 2 seizures and transient headache, fever, nausea, vomit, incontinence | |
Spangler (1996) | 15 | 30% marked improvement, 40% moderate, 30% slight improvement | Not specified | 8 cases unsteady gate, 7 transient urinary retention, 2 seizures, 1 embolism, 2 suicides | |
Dougherty (2003) | 11 | 31% of patients with more than 50% of improvement | 1 year | Not mentioned | |
Richter (2004) | 4 | No significant improvement | 1 year | 1 transient urinary incontinence, headache, and nausea | |
Ridout (2007) | 9 | 4 recovered, 5 unchanged | 14 months | Not mentioned | |
Subcaudate tractotomy | Knight (1964) | 15 | 8 cases recurred, 5 no symptoms, 3 slight symptoms | Not specified | 1 case of seizure |
Ström-Olsen (1971) | 75 | 31 completely recovered, 11 improved slight symptom, 18 improved persistent symptoms, 15 unchanged | 2.5 years | 3% lasting sequelae, 11% minor symptoms, 86% nonundersirable symptoms, 8 seizures | |
Bridges (1973) | 24 | 6 patients symptom-free, 11 much improved, 5 improved, 2 not improved, 0 worse | 3 years | 1 social disinhibition, 2 lethargy, 1 irritability, 5 patients with at least 1 convulsive episode | |
Göktepe (1975) | 78 | 27 patients symptom-free, 26 much improved, 16 improved, 9 not improved, 0 worse | 4.5 years | 3 suicides, 2 excessive eating, 2 volubility, 2 reduction social standards, 2 extravagance | |
Bartlett (1977) | 6 | 0 patients symptom-free, 3 much improved, 2 improved, 1 not improved, 0 worse | 1 year | Transient disinhibition, 1 mild aggressive behavior | |
Evans (1981) | 35 | 10 patients symptom-free and much improved, 11 improved, 14 not improved, 0 worse | 1 year | Not mentioned | |
Corn (1984) | 6 | General improvement of 57% in Hamilton scale | 2 weeks | Not mentioned | |
Lovett (1989) | 15 | 66% some reduction of symptoms, 33% lower frequency attacks, and 33% less severe symptoms | 11 years | 4 cases cardiac/respiratory failure, 33% died after 11 years | |
Poynton (1995) | 16 | 45% reduction of symptoms at maximum follow-up | 6 months | No lasting effect on neuropsychiatric function | |
Hodgkiss (1995) | 183 | 63 patients symptom-free and much improved, 53 improved, 57 not improved or worsened | 1 year | 3% mortality | |
Kim (2002) | 7 | 60% improvement at maximum follow-up in Hamilton depression scale | 4 years | 1 mild transient urinary incontinence | |
Limbic leucotomy | Kelly (1973) | 14 | 2 patients symptom-free, 2 much improved, 5 improved, 5 not improved, 0 worse | 2 years | Short period of confusion and lethargy, transient urinary incontinence, 1 suicide |
Mitchell-Heggs (1976) | 24 | 20% patients symptom-free, 6% much improved, 40% improved, 20% not improved, 13% worse | 16 months | Confusion, 1 case euphoria, 3 suicides, stereotyped and perseverative behavior | |
Montoya (2002) | 6 | 36% to 50% treatment responders | 59 months | 2 suicides, 4 seizures, 5 bladder incontinence, 2 memory problems, 1 infection, apathy | |
Sachdev (2005) | 23 | 5 patients symptom-free, 11 much improved, 3 improved, 3 not improved, 0 worse | 2 years | 2 cases epilepsy, 2 weight gain, 8 transient delirium, 6 suicide, 1 death respiratory-related | |
Other procedures | Pool (1949), topectomy | 8 | 3 cases socially rehabilitated, 1 at home but unstable, 4 improved moderately | Not specified | 5 transient urinary retentions, 2 hemiparesis, 7 cases with 2 or more seizures |
Laitinen (1973), anterior mesoloviotomy | 5 | 1 patient symptom-free, 2 improved, 2 unchanged | 1 year | 1 cases excessive hemorrhage | |
Vikki (1977), anterior mesoloviotomy | 4 | 1 patient symptom-free, 2 improved, 1 unchanged | Not specified | 3 cases with indifference (lack of judgment, self-criticism, and initiative) | |
Peraita (1977), open frontal leucotomy | 11 | 50% significant improvement at maximum follow-up | 2 years | Reported “post-leucotomy syndrome” | |
Mirsky (1980), multiple targets | 17 | 2 patients symptom-free, 7 much improved, 4 improved, 3 not improved, 1 worse | Not specified | 5 seizures, 5 pain syndrome, one third apathy or lethargy, two thirds disinhibition, 6 memory loss |
Deep brain stimulation
Author (year) | Number of patients | Outcome | Maximum follow-up | Complications | |
---|---|---|---|---|---|
Subgenual cingulate cortex | Mayberg (2005) | 6 | Striking and sustained remission in 4 of the patients | 6 months | Loss of energy and initiative, impaired concentration in 2 patients |
Neimat (2008) | 1 | Patient reincorporated to full-time job. 68% improvement on Hamilton-D scale | 30 months | Not mentioned | |
Lozano (2008) | 20 | 60% cases responded to stimulation, 35% patients met criteria for remission | 1 year | Infection, perioperative seizures, worsening in mood and irritability, pain in pulse generator site, perioperative headache | |
Nucleus accumbens | Schlaepher (2008) | 3 | One case responded significantly, marked differences between ON and OFF states | 23 months | No neurological or psychological side effects |
Ventral caudate/striatum | Aouizerate (2004) | 1 | Marked improvement of depression and anxiety until their remission | 15 months | Slight attention and executive function tests reduction |
Malone (2009) | 15 | 53.3% of cases responders to stimulation and 40% remission | 4 years | Pain at implantation site, hypomania, and probably mixed bipolar state | |
Aouizerate (2009) | 2 | Depression abated (without requirement of antidepressant after surgery in one case) | 15 months | Worsening of depressive symptoms in the first 3 months postsurgery | |
Inferior thalamic peduncle | Jimenez (2005) | 1 | Complete remission without necessity of medication after surgery | 2 years | Not mentioned |
Lateral habenula | Sartorius (2009) | 1 | Complete remission without necessity of medication after surgery | 60 weeks | Not mentioned |
Globus pallidus internus | Kosel (2007) | 1 | Significant improvement of 50% on Hamilton-D scale | 18 months | HDRS score decreased significantly after 15 and 18 months of stimulation |
Cerebellum | Health (1979) | 6 | 83% of patients showed significant improvement without necessity of postsurgery medication | 30 months | Major technical problems due to equipment failure |