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Predicting response to psychiatric surgery: a systematic review of neuroimaging findings
Benjamin Davidson1, Hrishikesh Suresh1, Maged Goubran1
1From the Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada (Davidson, Suresh, Hamani, Lipsman); and the Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada (Davidson, Goubran, Rabin, Meng, Mithani, Pople, Giacobbe, Hamani, Lipsman).
Background:
Psychiatric surgery, including deep brain stimulation and stereotactic ablation, is an important treatment option in severe refractory psychiatric illness. Several large trials have demonstrated response rates of approximately 50%, underscoring the need to identify and select responders preoperatively. Recent advances in neuroimaging have brought this possibility into focus. We systematically reviewed the psychiatric surgery neuroimaging literature to assess the current state of evidence for preoperative imaging predictors of response.
Methods:
We performed this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) frameworks, and preregistered it using PROSPERO. We systematically searched the Medline, Embase and Cochrane databases for studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in patients who underwent psychiatric surgery. We recorded and synthesized the methodological details, imaging results and clinical correlations from these studies.
Results:
After removing duplicates, the search yielded 8388 unique articles, of which 7 met the inclusion criteria. The included articles were published between 2001 and 2018 and reported on the outcomes of 101 unique patients. Of the 6 studies that reported significant findings, all identified clusters of hypermetabolism, hyperconnectivity or increased size in the frontostriatal limbic circuitry.
Limitations:
The included studies were few and highly varied, spanning 2 decades.
Conclusion:
Although few studies have analyzed preoperative imaging for predictors of response to psychiatric surgery, we found consistency among the reported results: most studies implicated overactivity in the frontostriatal limbic network as being correlated with clinical response. Larger prospective studies are needed.
Registration:
www.crd.york.ac.uk/prospero/display_record.php?RecordID=131151.
Insights
Preoperative neuroimaging may predict response to psychiatric surgery. Studies suggest overactivity in the frontostriatal limbic network correlates with positive outcomes, guiding patient selection for deep brain stimulation and ablation.
Area of Science:
- Neuroscience
- Psychiatry
- Medical Imaging
Background:
- Psychiatric surgery, including deep brain stimulation and stereotactic ablation, offers treatment for severe refractory psychiatric illness.
- Current response rates are around 50%, highlighting the need for preoperative patient selection.
- Advances in neuroimaging present an opportunity to identify potential responders before surgery.
Purpose of the Study:
- To systematically review the literature on preoperative neuroimaging predictors of response to psychiatric surgery.
- To assess the current evidence base for using neuroimaging to select patients for psychiatric surgery.
Main Methods:
- Systematic review conducted following PRISMA and MOOSE guidelines.
- Searched Medline, Embase, and Cochrane databases for relevant studies.
- Included studies reporting preoperative neuroimaging analyses correlated with clinical outcomes in psychiatric surgery patients.
Main Results:
- Seven studies published between 2001 and 2018, involving 101 patients, met the inclusion criteria.
- Six studies reported significant findings, consistently identifying hypermetabolism, hyperconnectivity, or increased size in the frontostriatal limbic circuitry.
- These imaging findings were correlated with clinical response to psychiatric surgery.
Conclusions:
- Despite the limited number and heterogeneity of studies, a consistent finding emerged regarding preoperative imaging predictors.
- Overactivity within the frontostriatal limbic network appears to correlate with positive clinical response to psychiatric surgery.
- Larger, prospective studies are necessary to validate these neuroimaging predictors.
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