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Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders
Bart Nuttin1, Hemmings Wu2, Helen Mayberg3
1Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium Chair of Committee of Neurosurgery for Psychiatric Disorders of the WSSFN and Department of Neurosurgery, UZ Leuven, Leuven, Belgium Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. WSSFN Committee on Neurosurgery for Psychiatric Disorders.
New global guidelines address psychiatric neurosurgery for treatment-resistant mental illnesses. They emphasize multidisciplinary teams and rigorous research, including randomized controlled trials, to improve patient safety and ethical conduct worldwide.
Area of Science:
- Neurosurgery
- Psychiatry
- Medical Ethics
Background:
- Neurosurgical procedures offer an option for patients with psychiatric illnesses refractory to standard treatments.
- Previous guidelines for psychiatric neurosurgery were developed by local or regional expert groups.
Purpose of the Study:
- To establish pragmatic worldwide guidelines for the safe and ethical conduct of psychiatric neurosurgery.
- To address diverse neuropsychiatric disorders, brain targets, and neurosurgical techniques, considering global healthcare heterogeneities.
Main Methods:
- Convened representatives from international psychiatric and neurosurgical societies.
- Elaborated and adopted a global set of guidelines for psychiatric neurosurgery.
- Incorporated considerations for cultural and social differences in healthcare environments.
Main Results:
- Stereotactic ablative procedures (e.g., cingulotomy, capsulotomy) for depression and OCD lack Level I evidence despite being considered established in some regions.
- Deep brain stimulation for psychiatric disorders remains investigational across all brain targets.
- Multidisciplinary teams are essential for safe and ethical psychiatric neurosurgery, requiring documented patient refractoriness, informed consent, and comprehensive follow-up.
Conclusions:
- The consensus document aims to enhance patient safety in psychiatric surgery globally.
- Encourages randomized controlled trials for psychiatric neurosurgery based on scientific rationale.
- Stresses the importance of experienced multidisciplinary teams for ethical and effective patient care.
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