Abstract
There are two types of psychosurgical interventions. The first consists in creating a lesion via stereotaxy using heat (thermocoagulation) or ionizing radiation (radiosurgery) in one or more precise areas of the brain. The second, more recent type of intervention uses stimulation to target both deep brain structures and the cortex or the vagus nerve. In contrast to previous techniques, the effects of stimulation are reversible and adaptable and make use of implanted devices: electrodes and stimulators.
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Notes
- 1.
Cf. p. 123.
- 2.
Cf. pp. 202–204.
- 3.
Cf. p. 358.
- 4.
Cf. p. 345.
- 5.
Chapter 4, p. 271.
- 6.
Chapter 5, p. 418.
- 7.
Talairach was the first to discuss the subject while Leksell published the first clinical results and popularized the technique.
- 8.
Cf. p. 125.
- 9.
Cf. p. 90.
- 10.
Cf. p. 124.
- 11.
Cf. p. 128.
- 12.
Cf. pp. 141 and 143.
- 13.
DTI is a technique using MRI to calculate the diffusion of water molecules for each pixel of the image. The water molecule is constrained in its diffusion by its surroundings. This type of imaging enables the position and orientation of fibers such as white matter bundles to be calculated indirectly.
- 14.
Cf. physiopathology of OCD p. 278.
- 15.
Cf. p. 187.
- 16.
Cf. the chapter summarizing the scales used in OCD, p. 273.
- 17.
Cf. p. 184.
- 18.
Ibid.
- 19.
See also p. 326.
- 20.
Cf. p. 310.
- 21.
Cf. p. 95.
- 22.
Cf. p. 133.
- 23.
Cf. p. 137.
- 24.
Cf. p. 49.
- 25.
An old X-ray imaging technique using a gas as a contrast medium to obtain images of ventricles in the brain (Fig. 3.7). The gas was injected by lumbar puncture, suboccipitally or even by direct puncture of the ventricles after trepanning. This test was replaced by MRI or brain scans used today.
- 26.
Cf. p. 358.
- 27.
Hyperactivity in the temporal cortex is witnessed, in particular of the hippocampus and of the amygdala.
- 28.
Hyperactivity of the central gray nuclei and of the thalamus can also be seen.
- 29.
Cf. p. 180.
- 30.
Ibid.
- 31.
Cf. p. 418.
- 32.
Cf. p. 93.
- 33.
Cf. p. 47.
- 34.
Cf. p. 93.
- 35.
This sort of operation is unthinkable with invasive surgical procedures such as stereotactic thermocoagulation. However, it would be conceivable in operations done with radiosurgery. In such a “sham” procedure, a stereotaxic frame is placed on the patient’s skull, the imaging is done but no radiation is released when the patient is inside the radiosurgery device. A team from São Paulo performed this procedure on an OCD patient. Over a year later, the same procedure was done, but this time releasing gamma rays. Thus, the patient was his own witness [115].
- 36.
This lacuna must however be nuanced in cases of severely depressed patients: this effect is considered marginal [338].
- 37.
Gy is the symbol for Gray, a unit that measures the amount of energy released.
- 38.
Scale of OCD severity (cf. p. 273).
- 39.
Details of this technique cf. p. 457.
- 40.
We have evoked p. 33 the memory of Clovis Vincent, who along with Thierry de Martel was one of the pioneers of neurosurgery in France. Vincent was a war surgeon during WWI. He was known for his “torpillage” technique: he used electrical stimulations to distinguish traumatised soldiers from those only pretending to be traumatized.
This French expression came from one of his patients who stated that “it turns you upside down like a torpedo (“torpille” in French).” Military staff and then the Undersecretary for Health, J. Godart became aware of this dubious practice and stated, “the emotion that it would arouse in Tours and in that region the procedure implemented by the head-physician of the neurology centre, Clovis Vincent […]. This procedure called “torpillage” was actually adopted and its therapeutic value shown at the meeting of neurologic physicians gathered under my initiative and who defined treatment methods for nervous system functional disorders […]. Do not take into account the emotions of the public, which gets easily impressed when not well informed. Nau, J. Y. 2011. When Dr. Clovis Vincent “torpedoed” his patients. Rev Med Suisse 7:630–631.
- 41.
Cf. p. 123.
- 42.
The ethicists J. Gybels, Jan and J. Fins (President of the American BioEthics Society), the psychiatrists L. Gabriel, P. Cosyns, D. Malone, B. Greenberg, S. Rasmunsen, the neurosurgeons A. Rezai, G. Friehs, B. Meryerson and the neurologist E. Montgomery.
- 43.
Cf. ethical safe-guards p. 443.
- 44.
Cf. pp. 210 and 290.
- 45.
Cf. p. 129.
- 46.
Cf. p. 146.
- 47.
Cf. p. 463.
- 48.
Cf. p. 123.
- 49.
Cf. p. 103.
- 50.
Ibid.
- 51.
Ibid.
- 52.
This distance can change depending on the type of electrode. Electrodes destined to stimulate “small” structures like the subthalamic nucleus, have more closely spaced contacts than those conceived for the stimulation of larger structures like the globus pallidus. The types of electrodes change depending on the area of stimulation.
- 53.
Other noninvasive brain recording techniques are those performed on the surface of the cortex like electroencephalograms (EEG). DBS electrode recording offers the advantage of having a very good temporal and spatial resolution and a good sound-to-noise ratio (SNR).
- 54.
Cf. Conflicts of interest p. 432.
- 55.
Cf. p. 187.
- 56.
Cf. 164.
- 57.
This test can be associated with the previous one to correct image distortions seen on MRI related to the magnetic field.
- 58.
This delay can vary depending on the chosen target. A clinical effect may occur in a matter of seconds which is the case of subgenual cortex DBS. Mayberg observes in the first five patients: “They all mentioned spontaneously acute effects like ‘sudden calm or lightness,’ ‘disappearance of the void,’ ‘a feeling of growing awareness’ […] in response to this electrical stimulation” [240].
- 59.
Cf. p. 123.
- 60.
Cf. p. 93.
- 61.
Cf. p. 95.
- 62.
Cf. p. 92.
- 63.
Cf. p. 124.
- 64.
Cf. p. 129.
- 65.
Cf. pp.142 and 143.
- 66.
Cf. also p. 358 about anorexia nervosa and p. 366 about the treatment of addiction using deep brain stimulation.
- 67.
Cf. the complications of capsulotomy, p. 179.
- 68.
Cf. p. 129.
- 69.
Cf. p. 278.
- 70.
Cf. p. 139.
- 71.
Cf. p. 93.
- 72.
Cf. p. 128.
- 73.
Cf. p. 125.
- 74.
Cf. p. 167.
- 75.
Cf. p. 193.
- 76.
Cf. p. 146.
- 77.
Cf. p. 187.
- 78.
Cf. p. 146.
- 79.
Cf. p. 359.
- 80.
Cf. p. 139.
- 81.
It is the detailed representation of the body or functions within a nerve structure.
- 82.
However, certain authors have questioned the validity of this animal-based model which compares these behavior iterations in monkeys with the rituals of an obsessive–compulsive disorder subject [220].
- 83.
Cf. p. 321.
- 84.
Cf. p. 232.
- 85.
Cf. p. 128.
- 86.
Cf. p. 129.
- 87.
Cf. p. 143.
- 88.
Cf. p. 98.
- 89.
Cf. p. 129.
- 90.
Cf. p. 112.
- 91.
Cf. p. 149.
- 92.
In Lozano’s study, two infections at the implant sites in the scalp and the thorax and a cutaneous erosion were recorded. The complications of this DBS technique and its frequencies are detailed on p. 206.
- 93.
This hypothesis implies that high frequency stimulation (100–180 Hz) would have an excitatory effect, and not an inhibitory effect, when it is applied to axons. The inhibitory effect concerns neuron and not axons [160].
- 94.
Cf. p. 146.
- 95.
Cf. p. 150.
- 96.
Ibid.
- 97.
Cf. p. 112.
- 98.
Cf. p. 187.
- 99.
Cf. p. 189.
- 100.
Cf. “Lesion or stimulation” p. 457 for more on this debate.
- 101.
Many of the rTMS targets were assessed in the treatment of OCD. The studies targeting the dorsolateral prefrontal cortex were inconclusive. However, the supplementary motor area and the orbifrontal cortex seem promising.
- 102.
Anterograde amnesia is partial or even complete loss of memory posterior to the disease, the accident, or the operation. The individual becomes incapable of building new memories. We could compare this situation to a computer in which the hard drive could read all the data but a defective writing mechanism would prevent new information from being recorded.
- 103.
Phosphene phenomena are flashes or lights appearing in the visual field. They can be caused by mechanical, electrical, or magnetic stimulation of the retina or the visual cortex, but also by a cellular destruction in the visual system.
- 104.
Cf. anatomy p. 90.
- 105.
Usually this area, which corresponds to area 46 and to a lesser extent area 9, is situated 5 cm in front of the point of scalp at which the right thumb can be made to contract using a coil.
- 106.
In 2009, Amiaz and et al. reported on a randomized, double-blinded study of a series of 48 smoking patients used to consuming at least 20 cigarettes every day. They received ten sessions of transcranial magnetic stimulation every day for 10 days. Results showed an objective decrease in tobacco use in the patients who were actually being stimulated [300].
- 107.
During the operation, the neuronavigation system allows a patient’s MRI images to be superimposed over her actual brain, the way a GPS superimposes a map over the actual route. It is then possible, with control panels, to precisely guide the progression of the electrode at the surface of the cortex.
- 108.
Cf. p. 98.
- 109.
Cf. p. 103.
- 110.
Cf. p. 107.
- 111.
Cf. p. 112.
- 112.
Cf. p. 93.
- 113.
Cf. p. 149.
- 114.
Ibid.
- 115.
SPECT and O-PET Scan.
- 116.
Cf. p. 95.
- 117.
Cf. p. 98.
- 118.
Cf. p. 103.
- 119.
Cf. p. 236.
- 120.
Remission signifies a decrease by more than half of the score on the Hamilton scale (HRSD) cf. p. 313, and response signifies a score below 10.
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Lévêque, M. (2014). Psychosurgical Procedures. In: Psychosurgery. Springer, Cham. https://doi.org/10.1007/978-3-319-01144-8_3
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