Staudt Michael D, Herring Eric Z, Gao Keming, Miller Jonathan P, Sweet Jennifer A
Department of Neurosurgery, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, United States.
Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, ON, Canada.
Front Neurosci. 2019 Feb 15;13:108. doi: 10.3389/fnins.2019.00108. eCollection 2019.
The treatment of psychiatric patients presents significant challenges to the clinical community, and a multidisciplinary approach to diagnosis and management is essential to facilitate optimal care. In particular, the neurosurgical treatment of psychiatric disorders, or "psychosurgery," has held fascination throughout human history as a potential method of influencing behavior and consciousness. Early evidence of such procedures can be traced to prehistory, and interest flourished in the nineteenth and early twentieth century with greater insight into cerebral functional and anatomic localization. However, any discussion of psychosurgery invariably invokes controversy, as the widespread and indiscriminate use of the transorbital lobotomy in the mid-twentieth century resulted in profound ethical ramifications that persist to this day. The concurrent development of effective psychopharmacological treatments virtually eliminated the need and desire for psychosurgical procedures, and accordingly the research and practice of psychosurgery was dormant, but not forgotten. There has been a recent resurgence of interest for non-ablative therapies, due in part to modern advances in functional and structural neuroimaging and neuromodulation technology. In particular, deep brain stimulation is a promising treatment paradigm with the potential to modulate abnormal pathways and networks implicated in psychiatric disease states. Although there is enthusiasm regarding these recent advancements, it is important to reflect on the scientific, social, and ethical considerations of this controversial field.
精神科患者的治疗给临床界带来了重大挑战，多学科的诊断和管理方法对于提供最佳治疗至关重要。特别是，精神疾病的神经外科治疗，即“精神外科手术”，在人类历史上一直作为一种影响行为和意识的潜在方法而备受关注。此类手术的早期证据可追溯到史前时期，随着对脑功能和解剖定位的深入了解，在19世纪和20世纪初这种兴趣蓬勃发展。然而，任何关于精神外科手术的讨论都不可避免地引发争议，因为20世纪中叶经眶额叶切除术的广泛和随意使用产生了深远的伦理影响，至今仍存在。有效精神药物治疗的同时发展几乎消除了对精神外科手术的需求和渴望，因此精神外科手术的研究和实践处于休眠状态，但并未被遗忘。最近，由于功能和结构神经影像学以及神经调节技术的现代进展，对非切除性治疗的兴趣再度兴起。特别是，深部脑刺激是一种有前景的治疗模式，有可能调节与精神疾病状态相关的异常通路和网络。尽管人们对这些最新进展充满热情，但反思这个有争议领域的科学、社会和伦理考量很重要。
