Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders

Bart Nuttin (Lead / Corresponding author), Hemmings Wu, Helen Mayberg, Marwan Hariz, Loes Gabriëls, Thorsten Galert, Reinhard Merkel, Cynthia Kubu, Osvaldo Vilela-Filho, Keith Matthews, Takaomi Taira, Andres M. Lozano, Gastón Schechtmann, Paresh Doshi, Giovanni Broggi, Jean Régis, 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

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    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 environmentsFindings: 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. © 2014 by the BMJ Publishing Group Ltd.
    Original languageEnglish
    Pages (from-to)1003-1008
    Number of pages6
    JournalJournal of Neurology, Neurosurgery and Psychiatry
    Issue number9
    Early online date20 Jan 2014
    Publication statusPublished - 2014


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