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Adverse events following neurosurgery

Published online by Cambridge University Press:  02 January 2018

C. Rück*
Affiliation:
Psychiatry Section, Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Hospital, SE-171 76 Stockholm, Sweden
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Abstract

Type
Columns
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Copyright © 2003 The Royal College of Psychiatrists 

Matthews & Eljamel (Reference Matthews and Eljamel2003) gave an excellent overview of the controversial field of neurosurgery for mental disorders (NMD). I agree with them that ‘the accumulated literature on neurosurgery for mental disorder remains highly unsatisfactory’ but would like to point to some recent evidence.

Matthews & Eljamel state that ‘there is surprisingly little evidence’ to support the occurrence of adverse personality change. In my opinion, some of the literature suggests otherwise. Herner (Reference Herner1961) noted that in a group of 116 capsulotomy cases, frontal lobe deficit syndrome was obvious at follow-up in 30%. In the anxiety group, 40% and 13%, respectively, had adverse events of mild and of modest severity. In another study (Reference Kullberg, Sweet, Obrador and Mart ín-RodríguezKullberg, 1977), capsulotomy caused ‘some personality changes in the majority of the patients’. Adverse events in those studies included fatigue, emotional blunting, emotional incontinence, indifference, low initiative, disinhibition and impaired sense of judgement.

In a very recent study (Reference Rück, Andréewitch and FlycktRück et al, 2003), 26 anxiety patients who had undergone bilateral thermocapsulotomy were followed up after a mean of 13 years. Psychiatric methods included symptom rating scales and neuropsychological testing. To avoid bias, ratings were done by psychiatrists not involved in patient selection and postoperative treatment. Seventeen of 23 patients alive at long-term follow-up were seen in person and relatives were interviewed. The reduction in anxiety ratings was significant both as 1-year and long-term follow-up. Seven patients were, however, rated as experiencing significant adverse events, the most prominent symptoms being apathy and dysexecutive behaviour; also neuropsychological performance was significantly worse in these patients. I therefore agree with Matthews & Eljamel that we must continue to evaluate the efficacy and safety of NMD.

Footnotes

EDITED BY STANLEY ZAMMIT

Declaration of interest

C.R. has participated in numerous educational events sponsored by. pharmaceutical companies and has been a consultant for Pfizer.

References

Herner, T. (1961) Treatment of mental disorders with frontal stereotaxic thermo-lesions: a follow-up study of 116 cases. Acta Psychiatrica Scandinavica Supplementum, 37, 4560.Google Scholar
Kullberg, G. (1977) Differences in effect of capsulotomy and cingulotomy. In Neurosurgical Treatment in Psychiatry, Pain, and Epilepsy (eds Sweet, W. H. Obrador, S. & Mart ín-Rodríguez, J.), pp. 301308. Baltimore, MD: University Park Press.Google Scholar
Matthews, K. & Eljamel, M. S. (2003) Status of neurosurgery for mental disorder in Scotland. Selective literature review and overview of current clinical activity. British Journal of Psychiatry, 182, 404411.Google Scholar
Rück, C. Andréewitch, S. Flyckt, K. et al (2003) Capsulotomy for refractory anxiety disorders: longterm follow-up of 26 patients. American Journal of Psychiatry, 160, 513521.Google Scholar
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