Advance in Mechanism of Drug Addiction and Treatment (review) / 中国康复理论与实践

@#Drug addiction is a chronic and relapsing brain disease, which causes damage to the health of addicts seriously, and causes huge social problems. Relapse is one of the major characteristics of drug addiction, and is the main problem to be solved. In the past several decades, the mechanisms, high relapse rates, abstinence of addiction were studied. The Results of these research findings are summarized in this review to provide a better overview of the mechanisms and treatments of addition in order to provide ideas for further research.

Bilateral anterior cingulotomy for refractory obsessive-compulsive disorder: Long-term follow-up results / 中国神经精神疾病杂志

Background Cingulotomy is alternative lesion treatment to anterior capsulotomy for severe obsessive-compulsive disorder (OCD) which is proved to be beneficial to alleviate the recurrent obsessive thoughts and uncontrollable, compulsive reactions. To investigate the long term efficacy and adverse cognitive effects of stereotactic bilateral anterior cingulotomy as a treatment for refractory obsessive compulsive disorder (OCD) patients,seventeen patients suffering from refractory OCD underwent stereotactic bilateral anterior cingulotomies and were followed for 24 months.Methods The Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Clinical Global Impression (CGI), and other neuropsychological tests were used to assess the efficacy and cognitive changes of cingulotomy.Tests were taken before surgery and 12 and 24 months after surgery.Results The mean improvement rate of the YBOCS score achieved from the baseline was 48%. Eight patients out of 17 met responder criteria. During the 24-month follow-up, there were no significant adverse effects observed after surgery.Conclusions Bilateral anterior cingulotomy for the treatment of refractory OCD was effective, and no other significant adverse cognitive effects on long-term follow-up were found.

Functional Neurosurgery for Psychiatric Disease / 대한정신약물학회지

Despite a long and controversial history, psychosurgery has persisted as a modern treatment option for some severe, medically intractable psychiatric disorders. The empirical basis of psychosurgery is weak because of the lack of well-designed investigations. Several carefully conducted studies in which independent evaluation has been made, however, show convincingly that highly selective stereotactic operations on the brain can benefit some carefully selected, chronically ill psychiatric patients with a low rate of unwanted side effects. The goal of this article is to review the current state of psychosurgery. In this review, the definition of psychosurgery, patient selection criteria, and anatomical and physiological rationales for anterior cingulotomy, subcaudate tractotomy, anterior capsulotomy, limbic leukotomy, vagus nerve stimulation and deep brain stimulation are discussed.

Bilateral Cingulotomy for the Intractable Cancer Pain: Case Report

The authors report two cases of intractable cancer pain, which was managed by bilateral cingulotomy. The technique involved stereotaxis using magnetic resonance guidance and local anesthesia, with the introduction of a mechanical and chemical lesion(absolute alcohol). Postoperative pain relief was excellent that lasted relatively prolonged period of time until disease has far advanced. There were no complications related to procedure. Bilateral stereotactic cingulotomy is considered safe, feasible and most of all, effective in the severe, disabling pain from metastatic lesion. Also, a invasive surgery with general anesthesia can be avoided.

Treatment of Intractable Cancer Pain by Stereotactic Bilateral Anterior Cingulotomy

OBJECTIVE: Although cingulotomy has been applied to patients with affective disorders more frequently, there are numerous reports of its use for the control of severe pain. The goal of this study was to investigate the role of stereotactic bilateral anterior cingulotomy for intractable cancer pain. METHOD:Between January and June, 2000, we underwent stereotactic bilateral anterior cingulotomy in 6 patients for intractable cancer pain with poor response to opioids. The patients were suffering from widespread musculoskeletal or visceral pain. We made four lesions along the two tracks on either side of the cingulate cortex. Result: In all patients, pain reliefs after cingulotomy were dramatic and immediate. Five out of six patients did not require any opioids and one patient could reduce dose of opioids. There were no deaths or serious complications related to the procedure. CONCLUSION: These results suggested that a bilateral anterior cingulotomy might be useful method to control intractable cancer pain associated with the widespread metastatic disease. To provide rationale of bilateral anterior cingulotomy in intractable cancer pain, the theoretical mechanisms and role of bilateral anterior cingulotomy are discussed, along with our surgical techniques and the course of our patients.

Surgical Experience of Stereotactic Psychosurgery for Psychiatric Diseases

The authors report surgical experiences in patients with severe psychiatric illness refractory to all other conventional treatments. All 5 patients in this series were referred from their own psychiatrists. One patient with aggressive-conductive disorder, who was cared for in a closed ward, underwent bilateral amygdalotomy and bifrontal leucotomy. Four patients with obsessive-compulsive disorder were treated by limbic leucotomy, which is a combination of subcaudate tractotomy and anterior cingulotomy. Target points were selected according to the individual symptoms of each patients. Target construction was performed under ventriculogram or computerized tomographic guidance, using a Hitchcock stereotactic frame. All the procedures were performed under local anesthesia, except for the patient with aggressive-conductive disorder for whom the surgery had to be performed under general anesthesia because of the incooperative nature of the patient. The result of each surgery was good without serious complication. During the follow-up period, all the patients were freed from disturbing symptoms and successfully returned to their premorbid social life. Psychosurgery can be helpful in certain patients with severe, chronic, disabling, and treatment-refractory psychiatric illness.

Surgical Experience of Stereotactic Psychosurgery for Psychiatric Diseases

The authors report surgical experiences in patients with severe psychiatric illness refractory to all other conventional treatments. All 5 patients in this series were referred from their own psychiatrists. One patient with aggressive-conductive disorder, who was cared for in a closed ward, underwent bilateral amygdalotomy and bifrontal leucotomy. Four patients with obsessive-compulsive disorder were treated by limbic leucotomy, which is a combination of subcaudate tractotomy and anterior cingulotomy. Target points were selected according to the individual symptoms of each patients. Target construction was performed under ventriculogram or computerized tomographic guidance, using a Hitchcock stereotactic frame. All the procedures were performed under local anesthesia, except for the patient with aggressive-conductive disorder for whom the surgery had to be performed under general anesthesia because of the incooperative nature of the patient. The result of each surgery was good without serious complication. During the follow-up period, all the patients were freed from disturbing symptoms and successfully returned to their premorbid social life. Psychosurgery can be helpful in certain patients with severe, chronic, disabling, and treatment-refractory psychiatric illness.