1Dr. Ramnarayan Ramchandran, 1Subas Pradhan
1Redcar and Cleveland Community Mental Health Services, Redcar, United Kingdom
For many centuries neurosurgery for psychiatric disorders (psychosurgery) was largely non existent especially in the middle ages. But many developments in recent years renewed the interest. Broca, Wernicke and many others developed the idea that neurological function does have an anatomical base. Similarly, studies on patients with head injury also helped develop the anatomical basis of neurological function.
Presently the use of DBS is gaining ground. DBS involves stereotactic implantation of electrodes that then continuously emit short high-frequency electrical impulses in order to modulate functional neuronal circuits. The tip of each electrode contains at least four poles. Postoperatively, this permits a wide range of modes of stimulation from outside.
Material(s) and Method(s):
After a general introduction on relevance of neurosurgery for psychiatric disorders an attempt has been made to discuss specific use of neurosurgical procedures in various psychiatric disorders. A specific emphasis has been made on DBS as a prototype of neurosurgical techniques in the above conditions. References have been collected from various sources including authors personal experiences/own cases, review of scientific literature and published (international) guidelines.
The results have been presented and discussed under the headings for specific psychiatric disorders. A list of references have been provided for further study.
Psychosurgery has endured popular backlash after indiscriminate application in the face of dubious efficacy in the first half of the 20th century. Compared with the imprecise destructive procedures of that era, DBS has the advantages of being precisely targeted, relatively minimally invasive, essentially reversible and non-destructive, and adjustable with respect to stimulation parameters. Moreover, our knowledge, technology and hardware have also improved tremendously giving us more precise and targeted outcomes.
Its about time we change our mindset about this scientific clinical breakthrough.