La neurochirurgie et les maladies psychiatriques résistantes. De la psychochirurgie lésionnelle à la neuromodulation réversible
Seance of wednesday 10 may 2023 (Neurochirurgie)
DOI number : 10.26299/c5dm-va61/emem.2023.17.03
Abstract
Psychosurgery inevitably carries its share of caricatured images, be it photographs of Walter Freeman in his truck or Jack Nicholson in "One Flew Over the Cuckoo's Nest". It is easy to forget that neither the National Commission for the Protection of Human Subjects in the USA (as early as 1977!) nor the National Consultative Ethics Committee for Life Sciences and Health in France (in 2002) have formally prohibited this transdisciplinary approach between psychiatry and neurosurgery.
Modern deep brain stimulation was developed in Grenoble, France by a neurosurgeon, Professor Benabid, in the late 1980s. This surgical technique has now been proven its efficacy in the treatment of movement disorders. Vagus nerve stimulation has been used for patients suffering from drug-resistant epilepsy for over 25 years. These neuromodulation techniques are reversible, customizable and minimally invasive. They represent only a part of the current possibilities of neuromodulation.
In parallel to these developments, psychiatry still faces a large number of patients suffering from severe and drug-resistant pathologies. Thus, between 15 to 30% of depressed patients present a persistent depressive episode despite at least two successive well-conducted antidepressant treatments. The development of new effective molecules requires significant investment and time. This medical treatment is not incompatible with a reasonable surgical approach.
The selection of patients and the choice of the neuromodulation method can only be considered during multidisciplinary consultation meetings. It is therefore necessary that exchanges between psychiatrists and neurosurgeons intensify in order to better manage patients suffering from severe psychiatric pathologies that are resistant to treatment. Will the 21st century be the century of "mature" psychosurgery?
Modern deep brain stimulation was developed in Grenoble, France by a neurosurgeon, Professor Benabid, in the late 1980s. This surgical technique has now been proven its efficacy in the treatment of movement disorders. Vagus nerve stimulation has been used for patients suffering from drug-resistant epilepsy for over 25 years. These neuromodulation techniques are reversible, customizable and minimally invasive. They represent only a part of the current possibilities of neuromodulation.
In parallel to these developments, psychiatry still faces a large number of patients suffering from severe and drug-resistant pathologies. Thus, between 15 to 30% of depressed patients present a persistent depressive episode despite at least two successive well-conducted antidepressant treatments. The development of new effective molecules requires significant investment and time. This medical treatment is not incompatible with a reasonable surgical approach.
The selection of patients and the choice of the neuromodulation method can only be considered during multidisciplinary consultation meetings. It is therefore necessary that exchanges between psychiatrists and neurosurgeons intensify in order to better manage patients suffering from severe psychiatric pathologies that are resistant to treatment. Will the 21st century be the century of "mature" psychosurgery?