Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

Bart Nuttin, Hemmings Wu, Helen Mayberg, Marwan Hariz, Loes Gabriëls, Thorsten Galert, Reinhard Merkel, Cynthia Kubu, Osvaldo Vilela-Filho, Keith Matthews, Takaomi Taira, Andres M. Lozano, Gastoń Schechtmann, Paresh Doshi, Giovanni Broggi, Jean Reǵis, Ahmed Alkhani, Bomin Sun, Sam Eljamel, Michael SchulderMichael Kaplitt, Emad Eskandar, Ali Rezai, Joachim K. Krauss, Paulien Hilven, Rick Schuurman, Pedro Ruiz, Jin Woo Chang, Paul Cosyns, Nir Lipsman, Juergen Voges, Rees Cosgrove, Yongjie Li, Thomas Schlaepfer

Research output: Contribution to journalArticle

80 Scopus citations

Abstract

Background: For patients with psychiatric illnesses remaining refractory to 'standard' therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups. Methods: To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments. Findings: The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered 'established ' in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients. Interpretation: This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety.

Original languageEnglish (US)
Pages (from-to)1003-1008
Number of pages6
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume85
Issue number9
DOIs
StatePublished - Sep 2014
Externally publishedYes

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ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Nuttin, B., Wu, H., Mayberg, H., Hariz, M., Gabriëls, L., Galert, T., Merkel, R., Kubu, C., Vilela-Filho, O., Matthews, K., Taira, T., Lozano, A. M., Schechtmann, G., Doshi, P., Broggi, G., Reǵis, J., Alkhani, A., Sun, B., Eljamel, S., ... Schlaepfer, T. (2014). Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. Journal of Neurology, Neurosurgery and Psychiatry, 85(9), 1003-1008. https://doi.org/10.1136/jnnp-2013-306580