[Use of 18F-FDG positron emission tomography in the diagnosis and evaluation of the efficiency of treatment for resistant anxiety-obsessive disorders].

The purpose of the investigation was to study the capacities of 18F-FDG positron emission tomography (PET) in the diagnosis and evaluation of the efficiency of treatment for resistant anxiety-obsessive disorders (AOD). 18F-FDG PET was performed in 21 patients with AOD. In 17 cases, the studies were made before and after therapy. Fourteen patients underwent stereotactic surgical intervention. Pretreatment 18F-FDG PET showed that the patients with AOD had hypermetabolism in the cingulated gyri, caudate nuclei, and thalamus in 7, 8, and 6 cases, respectively. A varying clinical improvement (by the Y-OCS and Spilberger scales) was observed in all the examinees after complex or drug treatment throughout the follow-up. According to the data of PET, these patients were observed to have significantly reduced metabolism of glucose in the anterior cingulated guri and its increased metabolism in the heads of the caudate nuclei and thalamus. The metabolic changes detected by PET are strongly and moderately correlated with the pattern of a clinical picture (p < 0.05). It is concluded that the use of 18F-FDG PET makes it possible to provide more accurate insight into the pathogenetic mechanisms responsible for the development of AOD, to objectify the choice of targeted intracerebral structures in order to perform stereotactic neurosurgical interventions, and to optimize drug therapy and to evaluate the efficiency of the treatment performed in early periods.

Differential approach to psychosurgery of obsessive disorders.

One of the most frequent indications of psychosurgical treatment is incurable obsessions. Up to now, capsulotomy or cingulotomy has been preferred. In our opinion, the variety of obsessive conditions require a more thorough approach to the selection of interbrain targets. Forty-seven patients with pure obsessive-compulsive disorders as well as disorders connected with depressions, epileptic syndrome, schizophreniform state and Gilles de la Tourette's syndrome with extremely severe resistance to medical therapy were examined. Eighteen patients were operated on. Surgical treatment is permissible only in cases fulfilling the three following criteria: (1) clinicopsychopathological permissibility (duration of disease, resistance to medication, psychopathological status); (2) physiological permissibility (the presence of a brain target, defining the psychopathological status), and (3) technical permissibility (the availability of proper stereotactic, imaging, electrophysiological and other apparatus necessary to carry out the surgical treatment). One supposes that the outcome of surgical treatment is determined by all three criteria. For the purpose of improving the efficiency of stereotactic treatment, a number of methods of surgical treatment depending on the psychopathological status are suggested. For example, in case of comorbidity of obsession with the epileptiform syndrome, we suggest cingulotomy (capsulotomy) and amygdalotomy; in case of comorbidity with depression we suggest cingulotomy and innominatotomy. The long-term observation of the outcome of stereotactic treatment covers a period from 2 up to 9 years.

[Stereotaxic cingulotomy in the complex treatment of a schizophrenic patient with obsessive-compulsive disorder, resistant to treatment]. / Stereotaksicheskaia tsingulotomiia v kompleksnom lechenii bol'nogo shizofreniei s terapevticheski rezistentnymi obsessivno-kompul'- sivnymi narusheniiami.

The authors describe a case of continuous conservative treatment of a patient suffering from severe obsessions. At the definite stage of the disease, the patient underwent psychosurgical operation--bilateral anterior stereotaxic cingulotomy . The surgical intervention was necessitated by dramatic and steady deterioration of the patient's condition, loss of work fitness, suggesting official registration of disability; appearance of suicidal intentions. After the operation the patient started his work again in accordance with his specialty; the question about disability registration did not arise any more.

[Electrical resistance of nerve tissue as a diagnostic criterion of pre-convulsive states]. / Elektricheskoe soprotivlenie nervnoi tkani kak diagnosticheskii kriterii predsudorozhnogo sostoianiia.

For diagnosing pre-convulsive states use is made, as a rule, of electroencephalography. This method, however, not always gives satisfactory results. The authors present the results of experimental studies of the nervous tissue impedance in the period preceding the convulsive seizure induced in laboratory animals by electric stimulation of the limbic structures of the brain. The experiments showed that a few seconds before the generalization of the convulsive process one could note certain changes in the electric conductivity of the nervous tissue. These changes make it possible to take measures for preventing the seizure.

[Regulation of complex forms of animal behavior on the basis of electric stimulation of the emotionogenic structures of the brain]. / Reguliatsiia slozhnykh form povedeniia zhivotnogo na osnove élektricheskogo razdrazheniia émotsiogennykh struktur mozga

The paper considers the possibility of controlling animal behaviour by acting on the positive emotional centres. It has been shown that in an experimental chamber under certain conditions of stimulation it is possible to control the motor-serach behaviour of dogs. This emphasized the possibility, in principal, for evolving biotechnical control systems of the "technical facility-bioobject" class.