Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders.
BACKGROUND
For patients with psychiatric illnesses remaining refractory to 'standard' therapies, neurosurgical procedures may be considered. Guidelines for safe and ethical conduct of such procedures have previously and independently been proposed by various local and regional expert groups.


METHODS
To expand on these earlier documents, representative members of continental and international psychiatric and neurosurgical societies, joined efforts to further elaborate and adopt a pragmatic worldwide set of guidelines. These are intended to address a broad range of neuropsychiatric disorders, brain targets and neurosurgical techniques, taking into account cultural and social heterogeneities of healthcare environments.


RESULTS
The proposed consensus document highlights that, while stereotactic ablative procedures such as cingulotomy and capsulotomy for depression and obsessive-compulsive disorder are considered 'established' in some countries, they still lack level I evidence. Further, it is noted that deep brain stimulation in any brain target hitherto tried, and for any psychiatric or behavioural disorder, still remains at an investigational stage. Researchers are encouraged to design randomised controlled trials, based on scientific and data-driven rationales for disease and brain target selection. Experienced multidisciplinary teams are a mandatory requirement for the safe and ethical conduct of any psychiatric neurosurgery, ensuring documented refractoriness of patients, proper consent procedures that respect patient's capacity and autonomy, multifaceted preoperative as well as postoperative long-term follow-up evaluation, and reporting of effects and side effects for all patients.


CONCLUSIONS
This consensus document on ethical and scientific conduct of psychiatric surgery worldwide is designed to enhance patient safety.
Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium Chair of Committee of Neurosurgery for Psychiatric Disorders of the WSSFN and Department of Neurosurgery, UZ Leuven, Leuven, Belgium Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. WSSFN Committee on Neurosurgery for Psychiatric Disorders.
Bart
B
Nuttin
Research Group of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, KU Leuven, Leuven, Belgium.
Hemmings
H
Wu
Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. Department of Psychiatry, Emory University School of Medicine, Atlanta, GA, USA.
Helen
H
Mayberg
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Clinical Neuroscience, UCL Institute of Neurology, Queen Square, London, Umea University, Umea, Sweden.
Marwan
M
Hariz
WSSFN Committee on Neurosurgery for Psychiatric Disorders Chair of the Committee of Neurosurgery for Psychiatric Disorders, Belgium and Belgium and Department of Psychiatry, UZ Leuven, Leuven, Belgium.
Loes
L
Gabriëls
Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. Deutsches Referenzzentrum für Ethik in den Biowissenschaften, Bonn, Germany.
Thorsten
T
Galert
Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. Universität Hamburg/Juristische Fakultät Lehrstuhl für Strafrecht und Rechtsphilosophie, Hamburg, Germany.
Reinhard
R
Merkel
Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, USA.
Cynthia
C
Kubu
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Neurosciences, Institute of Neurology of Goiânia, Stereotactic and Functional Neurosurgery Service, Medical School, Federal University of Goiás, Medical School, Pontifical Catholic University of Goiás, Goiânia, Brazil.
Osvaldo
O
Vilela-Filho
WSSFN Committee on Neurosurgery for Psychiatric Disorders Advanced Interventions Service and Division of Neuroscience, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, UK.
Keith
K
Matthews
Past-president of WSSFN and Chair of Committee of Stereotactic and Functional Neurosurgery, World Federation of Neurosurgical Societies (WFNS), and Department of Neurosurgery, World Federation of Neurosurgical Societies (WFNS), Tokyo Women's Medical University, Tokyo, Japan.
Takaomi
T
Taira
Past-president of WSSFN and Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
Andres M
AM
Lozano
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Neurosurgery and Clinical Neuroscience, Karolinska Institutet and University Hospital, Stockholm, Sweden.
Gastón
G
Schechtmann
WSSFN Committee on Neurosurgery for Psychiatric Disorders Stereotactic and Functional Neurosurgery Program, Jaslok Hospital and Research Centre, Mumbai, India.
Paresh
P
Doshi
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Neurosurgery, Instituto Neurologico C. Besta, Milano, Italy.
Giovanni
G
Broggi
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Functional Neurosurgery, Hôpital La Timone, Aix-Marseille Université, Marseille, France.
Jean
J
Régis
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Neurosciences, King Faisal Specialist Hospital and Research Centre, AlFaisal University, Riyadh, Saudi Arabia.
Ahmed
A
Alkhani
WSSFN Committee on Neurosurgery for Psychiatric Disorders Center for Functional Neurosurgery, Shanghai Jiao Tong University Rui Jin Hospital, Shanghai, China.
Bomin
B
Sun
WSSFN Committee on Neurosurgery for Psychiatric Disorders Centre of Neurosciences Department of Neurosurgery, Ninewells Hospital and Medical School Dundee, Dundee, Scotland, UK.
Sam
S
Eljamel
Department of Neurosurgery, Hofstra North Shore LIJ School of Medicine, North Shore University Hospital, Manhasset, NY, USA.
Michael
M
Schulder
Member of the Psychiatric Surgery Committee of the ASSFN and Department of Neurological Surgery, Weill Cornell Medical College, NY, USA.
Michael
M
Kaplitt
Member of the Psychiatric Surgery Committee of the ASSFN and Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Emad
E
Eskandar
Past President, American Society of Stereotactic and Functional Neurosurgery (ASSFN), Department of Neurosurgery, American Society of Stereotactic and Functional Neurosurgery (ASSFN), Ohio State University, Ohio, USA.
Ali
A
Rezai
President of ESSFN and WSSFN, Department of Neurosurgery, Medical University of Hannover, Hannover, Germany.
Joachim K
JK
Krauss
KU Leuven, Belgium.
Paulien
P
Hilven
Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands.
Rick
R
Schuurman
President of WPA, Department of Psychiatry and Behavioral Sciences, Miami Miller School of Medicine, Miami, USA.
Pedro
P
Ruiz
WSSFN Committee on Neurosurgery for Psychiatric Disorders President of Asian Australasian Society for Stereotactic & Functional Neurosurgery Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
Jin Woo
JW
Chang
Committee of Neurosurgery for Psychiatric Disorders, Belgium, Kortenberg, Belgium.
Paul
P
Cosyns
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
Nir
N
Lipsman
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Stereotactic Neurosurgery, Otto-von-Guericke University Magdeburg and Leibniz-Institute for Neurobiology, Magdeburg, Germany.
Juergen
J
Voges
WSSFN Committee on Neurosurgery for Psychiatric Disorders Department of Neurosurgery, Brown University, Providence, RI, USA.
Rees
R
Cosgrove
Department of Neurosurgery, Xuanwu Hospital, Beijing, China.
Yongjie
Y
Li
Working Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application'. This Working Group is organised by the Europäische Akademie GmbH (Bad Neuenahr-Ahrweiler, Germany, http://www.ea-aw.de). It consists of an interdisciplinary and international team of neurosurgeons, neurologists, psychiatrists, neuropsychologists, bioethicists, philosophers and legal scholars, analysing ethical issues arising from the application of Deep Brain Stimulation for Psychiatric Disorders. Questions such as critical issues around regulatory processes and ethical guidance for the management of conflicts of interest for researchers, engineers and clinicians engaged in the development of therapeutic deep brain stimulation have been comprehensively studied and the results have been published under common authorship. Chair of the Focus Group 'Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application', Chair of the Task Force on Brain Stimulation of the World Federations of Societies of Biological Psychiatry, Chair of the Section of Experimental Brain Stimulation Methods of the German Association of Psychiatry, Psychotherapy and Psychosomatics and member of the Operational Committee on Sections of the World Psychiatric Association. He is professor of Psychiatry and Psychotherapy at the University of Bonn, Germany, and Associate Professor of Psychiatry and Mental Health at The Johns Hopkins University, Baltimore, MD, USA.
Thomas
T
Schlaepfer
D001921:Brain / Q000601:surgery*; D032921:Consensus; D006801:Humans; D001523:Mental Disorders / Q000601:surgery*; D012955:Societies, Medical; D013238:Stereotaxic Techniques / Q000941:ethics / Q000592:standards
NEUROPSYCHOLOGY; NEUROSURGERY; PSYCHIATRY