Neurosurgery to Enhance Brain Function

Author(s):  
Reuben David Johnson ◽  
Dirk De Ridder ◽  
Grant Gillett

The aim of this chapter is to evaluate the potential for neurosurgical strategies to enhance brain function. These developments are considered in the context of the history of psychosurgery, which has shaped the ethical landscape in which future invasive surgical interventions will be evaluated. Consideration is given to the ethical, moral, legal, and socioeconomic implications posed by existing electrical modulation technologies, including future neurosurgical strategies, such as deep brain stimulation for cognitive or mood enhancement. The potential demand for the non-therapeutic use of these surgical strategies poses economic and legislative problems.

Author(s):  
Nicole C. R. McLaughlin ◽  
Benjamin D. Greenberg

Interest in psychiatric neurosurgery has waxed and waned since the 1930s. This chapter reviews the history of these methods, with a focus on OCD. This review of lesion procedures and deep brain stimulation includes neuropsychological and neuroimaging research in the context of putative neurocircuitry underlying symptoms and response to treatment. The chapter highlights how an abundance of caution is needed, as well as key issues in long-term management of patients so treated.


2020 ◽  
Vol 11 ◽  
pp. 444
Author(s):  
Samir Kashyap ◽  
Rita Ceponiene ◽  
Paras Savla ◽  
Jacob Bernstein ◽  
Hammad Ghanchi ◽  
...  

Background: Tardive tremor (TT) is an underrecognized manifestation of tardive syndrome (TS). In our experience, TT is a rather common manifestation of TS, especially in a setting of treatment with aripiprazole, and is a frequent cause of referrals for the evaluation of idiopathic Parkinson disease. There are reports of successful treatment of tardive orofacial dyskinesia and dystonia with deep brain stimulation (DBS) using globus pallidus interna (GPi) as the primary target, but the literature on subthalamic nucleus (STN) DBS for tardive dyskinesia (TD) is lacking. To the best of our knowledge, there are no reports on DBS treatment of TT. Case Description: A 75-year-old right-handed female with the medical history of generalized anxiety disorder and major depressive disorder had been treated with thioridazine and citalopram from 1980 till 2010. Around 2008, she developed orolingual dyskinesia. She was started on tetrabenazine in June 2011. She continued to have tremors and developed Parkinsonian gait, both of which worsened overtime. She underwent DBS placement in the left STN in January 2017 with near-complete resolution of her tremors. She underwent right STN implantation in September 2017 with similar improvement in symptoms. Conclusion: While DBS-GPi is the preferred treatment in treating oral TD and dystonia, DBS-STN could be considered a safe and effective target in patients with predominating TT and/or tardive Parkinsonism. This patient saw a marked improvement in her symptoms after implantation of DBS electrodes, without significant relapse or recurrence in the years following implantation.


2017 ◽  
Vol 43 (3) ◽  
pp. E12 ◽  
Author(s):  
Christen M. O’Neal ◽  
Cordell M. Baker ◽  
Chad A. Glenn ◽  
Andrew K. Conner ◽  
Michael E. Sughrue

The history of psychosurgery is filled with tales of researchers pushing the boundaries of science and ethics. These stories often create a dark historical framework for some of the most important medical and surgical advancements. Dr. Robert G. Heath, a board-certified neurologist, psychiatrist, and psychoanalyst, holds a debated position within this framework and is most notably remembered for his research on schizophrenia. Dr. Heath was one of the first physicians to implant electrodes in deep cortical structures as a psychosurgical intervention. He used electrical stimulation in an attempt to cure patients with schizophrenia and as a method of conversion therapy in a homosexual man. This research was highly controversial, even prior to the implementation of current ethics standards for clinical research and often goes unmentioned within the historical narrative of deep brain stimulation (DBS). While distinction between the modern practice of DBS and its controversial origins is necessary, it is important to examine Dr. Heath’s work as it allows for reflection on current neurosurgical practices and questioning the ethical implication of these advancements.


2022 ◽  
Vol 15 ◽  
Author(s):  
Yu Tian ◽  
Jiaming Wang ◽  
Xin Shi ◽  
Zhaohai Feng ◽  
Lei Jiang ◽  
...  

Patients requiring deep brain stimulation due to intracerebral metallic foreign substances have not been reported elsewhere in the world. Additionally, the long-term effects of metallic foreign bodies on deep brain stimulation (DBS) are unknown. A 79-year-old man with a 5-year history of Parkinson's disease (PD) reported that, 40 years ago, while playing with a pistol, a metallic bullet was accidentally discharged into the left brain through the edge of the left eye, causing no discomfort other than blurry vision in the left eye. DBS was performed due to the short duration of efficacy for oral medication. Because the bullet was on the left subthalamic nucleus (STN) electrode trajectory and the patient's right limb was primarily stiff, the patient received globus pallidus interna (GPi)-DBS implantation in the left hemisphere and STN-DBS implantation in the right hemisphere. During a 6-month postoperative follow-up, the patient's PD symptoms were effectively managed with no noticeable discomfort.


2000 ◽  
Vol 93 (1) ◽  
pp. 127-128 ◽  
Author(s):  
Albert E. Telfeian ◽  
John A. Boockvar ◽  
Tanya Simuni ◽  
Jurg Jaggi ◽  
Brett Skolnick ◽  
...  

✓ Deep brain stimulation (DBS) of the ventralis intermedius nucleus (Vim) is a safe and effective treatment for essential tremor. Bipolar disorder and essential tremor had each been reported to occur in association with Klinefelter syndrome but the three diseases have been reported to occur together in only one patient. The genetic basis and natural history of these disorders are not completely understood and may be related rather than coincidental. The authors report on a 23-year-old man with Klinefelter syndrome (47,XXY) and bipolar disorder who was treated successfully with unilateral DBS of the thalamic Vim for essential tremor.


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