title: Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression.
abstract: BACKGROUND
  There is very limited evidence for the efficacy of any specific therapeutic intervention in chronic, treatment refractory major depression. Thermal anterior capsulotomy (ACAPS) is a rarely performed but established therapeutic procedure for this patient group. While benefit has been claimed, previous ACAPS reports have provided limited information. Detailed prospective reporting of therapeutic effects and side effects is required.
  
  
  OBJECTIVE
  To report a prospective study of therapeutic effect, mental status, quality of life, social functioning and neurocognitive functioning in individuals with chronic treatment refractory major depression, treated with ACAPS.
  
  
  METHODS
  A prospective case series of 20 patients treated with ACAPS between 1992 and 1999 were reassessed at a mean follow-up of 7.0±3.4 years. Data were collected preoperatively and at long term follow-up. Structural MRI was performed in 14 participants.
  
  
  RESULTS
  According to a priori criteria, at long term follow-up, 50% were classified as 'responders' and 40% as 'remitters'. Fifty-five per cent were classified as 'improved'; 35% were 'unchanged'; and 10% had 'deteriorated'. Neurocognitive and personality testing were not significantly different at follow-up. A trend towards improvement in some aspects of executive neuropsychological functioning was observed. Significant adverse effects were infrequent and there were no deaths.
  
  
  CONCLUSIONS
  ACAPS may represent an effective intervention for some patients with chronic, disabling, treatment refractory major depression that has failed to respond to other therapeutic approaches. The adverse effect burden within this population was modest, with no evidence of generalised impairment of neurocognitive functioning.
authors.affiliation: Advanced Interventions Service, Area 7, Level 6, South Block, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. david.christmas@nhs.net
authors.forename: David
authors.initials: D
authors.lastname: Christmas
authors.forename: M Sam
authors.initials: MS
authors.lastname: Eljamel
authors.forename: Sharon
authors.initials: S
authors.lastname: Butler
authors.forename: Hiral
authors.initials: H
authors.lastname: Hazari
authors.forename: Robert
authors.initials: R
authors.lastname: MacVicar
authors.forename: J Douglas
authors.initials: JD
authors.lastname: Steele
authors.forename: Alison
authors.initials: A
authors.lastname: Livingstone
authors.forename: Keith
authors.initials: K
authors.lastname: Matthews
mesh_terms: D000328:Adult; D003865:Major Depressive Disorder / Q000523:psychology / Q000601:surgery*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D020772:Internal Capsule / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010552:Personality Assessment; D011183:Postoperative Complications; D011446:Prospective Studies; D011612:Psychosurgery / Q000009:adverse effects / Q000379:methods*; D011788:Quality of Life / Q000523:psychology; D016896:Treatment Outcome