Popular psychosurgery

Psychiatric Quarterly -     

Present status of psychosurgery in Spain

In order to know the present activity of psychosurgery in Spain, and the opinion of neurosurgeons relative to it, a survey was designed and applied to all active neurosurgeons in our country. We obtained data from at least one neurosurgeon from the 74 neurosurgical centers in Spain (response rate= 100%). Only 6 neurosurgeons performed psychosurgical interventions. In total, 121 psychosurgeries were performed between 1999 and 2003, 75.7% of them in private centers. The most frequent indication is obsessive-compulsive disorder and the most frequent technique is anterior capsulotomy, although techniques and indications differ among the practising neurosurgeons. Those not performing them cite lack of patient referral (54.4%) or unexperience (36.8%) as the causes. A suspected lack of efficacy or the possible adverse effects are seldom expressed. The possibility of using deep brain stimulation for psychiatric indications, as well as the experience of some neurosurgeons and the favorable opinion of the rest, might increase the number of operations in our country.     

Treatment of obsessive-compulsive disorder by psychosurgery

We report a longitudinal study of 26 patients with medically intractable obsessive-compulsive disorder (OCD) who were treated with psychosurgery and had a comprehensive follow-up for a mean 10 years. Seventeen patients had combined orbitomedial and cingulate lesions, 6 cingulate lesions only and 3 orbitomedial lesions only. Eighteen patients were interviewed personally and lesions verified on magnetic resonance imaging scans in fourteen. On a 6-point global rating scale, 10 (38%) patients had obvious improvement, another 6 (23%) showed mild improvement of doubtful clinical value, and the remaining 10 showed either no change (n= 6; 23%) or were judged to be worse (n= 4; 15%). Both obsessive and compulsive symptoms improved, and this change was independent of the changes in anxiety and depression scores. No significant predictors of improvement were identified. Patients with cingulate lesions only fared worse. Eight patients who had a second operation did not show much improvement. A comparison of a subgroup of patients with 10 matched nonsurgical OCD controls supported the contention that the improvement in OCD was attributable to the psychosurgery. Important adverse effects in the stereotactic surgery group (n= 20) were epilepsy (1 patient) and personality change (2 patients). The psychosurgery group performed relatively poorly on the Wisconsin Card Sort Test but did not show any deterioration in Wechsler Intelligence and Memory scores.