Innovative perspectives in limbic surgery using deep brain stimulation

Abstract

Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.

Keywords: aggressiveness; anxiety; dementia; drug usage; eating disorders; limbic surgery; psychosurgery; transhumanism.

FIGURE 1

Targets of new indications for DBS. In this representative scheme, different anatomical DBS sites are shown according to pathologies: Addictions (Cingulum, Nucleus accumbens [Na]); Anorexia (Rostromedial Tegmental Nucleus, Subcallosal cingulate [Sc]); Anxiety (Na, Bed Nucleus of Stria Terminalis, Hypothalamus); Aggressiveness (Posterior hypothalamus, cingulum and amygdala); Alzheimer’s disease (Fornix/hypothalamus, Nucleus Basalis of Meynert; Ventral capsule/ventral Striatum); Schizophrenia (Na, anterior Corpus callosum, Habenula); and Obesity (Anteromedial Hypothalamus, Na) for performing DBS therapy.