Status of neurosurgery for mental disorder in Scotland. Selective literature review and overview of current clinical activity.
BACKGROUND
Despite the application of ablative neurosurgical treatments for intractable mental disorder throughout most of the past century, unequivocal evidence for efficacy has not been provided.


OBJECTIVE
To review the status of ablative neurosurgery for mental disorder and to describe the activities of the Scottish national service.


METHODS
Relevant literature is reviewed alongside a description of recent clinical activity.


RESULTS
Neurosurgical treatment is offered to a small number of patients severely disabled by otherwise intractable mental disorder. There are inequalities in the strength of evidence to support the use of some of these procedures. The frequency and severity of adverse effects remains unclear. We are collecting data that should inform future practice.


CONCLUSIONS
Modern neurosurgery can offer clinically meaningful symptom relief and improved function for 'untreatable' patients with chronic, severe depression and obsessive-compulsive disorder. However, follow-up studies of greater rigour are required. The potential role of non-ablative alternatives remains unclear.
Ninewells Hospital and Medical School, Dundee, Scotland, UK. k.matthews@dundee.ac.uk
Keith
K
Matthews
Muftah S
MS
Eljamel
D001921:Brain / Q000601:surgery; D003866:Depressive Disorder / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000601:surgery*; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000941:ethics / Q000379:methods*; D009771:Obsessive-Compulsive Disorder / Q000601:surgery; D018579:Patient Selection; D012606:Scotland; D013238:Stereotaxic Techniques; D016896:Treatment Outcome