The prefrontal area and psychosurgery

The Surgical Elimination of Violence? Conflicting Attitudes towards Technology and Science during the Psychosurgery Controversy of the 1970s

In the 1970s a public controversy erupted over the proposed use of brain operations to curtail violent behavior. Civil libertarians, civil rights and community activists, leaders of the anti-psychiatry movement, and some U.S. Congressmen charged psychosurgeons and the National Institute of Mental Health, with furthering a political project: the suppression of dissent. Several government-sponsored investigations into psychosurgery rebutted this charge and led to an official qualified endorsement of the practice while calling attention to the need for more "scientific" understanding and better ethical safeguards. This paper argues that the psychosurgery debate of the 1970s was more than a power struggle between members of the public and the psychiatric establishment. The debate represented a clash between a postmodern skepticism about science and renewed focus on ultimate ends, on the one hand, and a modern faith in standards and procedures, a preoccupation with means, on the other. These diverging commitments made the dispute ultimately irresolvable.

Deep brain stimulation and ablation for obsessive compulsive disorder: evolution of contemporary indications, targets and techniques

Surgical therapy for treatment-resistant obsessive compulsive disorder (OCD) remains an effective option for well-selected patients managed within a multidisciplinary setting. Historically, lesions within the limbic system have been used to control both obsessive thoughts and repetitive compulsions associated with this disease. We discuss classical targets as well as contemporary neuromodulatory approaches that have been shown to provide symptomatic relief. Recently, deep brain stimulation (DBS) of the anterior limb of the internal capsule/ventral striatum received Conformité Européene (CE) mark and Food and Drug Administration (FDA) approvals for treatment of intractable OCD. Remarkably, this is the first such approval for neurosurgical intervention in a strictly psychiatric indication in modern times. This target is discussed in detail along with alternative targets currently being proposed. We close with a discussion of gamma knife capsulotomy, a modality with deep historical roots. Further directions in the surgical treatment of OCD will require better preoperative predictors of postoperative responses, optimal selection of individualized targets, and rigorous reporting of adverse events and standardized outcomes. To meet these challenges, centers must be equipped with a multidisciplinary team and patient-centered approach to ensure adequate screening and follow up of patients with this difficult-to-treat condition.

Deep brain stimulation for obsessive-compulsive disorder: subthalamic nucleus target

Because of its reversibility and adaptability, deep brain stimulation (DBS) has recently gained interest in psychiatric disorders, such as obsessive-compulsive disorders (OCD) and depression. In OCD, DBS is now an alternative procedure to lesions of fascicles such as the anterior capsule, which links the orbitofrontal cortex, the cingulum, and the thalamus, and has been applied to new target such as the nucleus accumbens, with promising results. However, a recent interest has been developed toward the subthalamic nucleus (STN), a key structure of the basal ganglia that connects the motor, limbic, and associative systems. It is known from patients with Parkinson disease that STN-DBS can have significant effects on mood and cognition. Those transient effects are usually seen as "side effects" in Parkinson disease, but are clues to the underappreciated role that STN plays in the limbic circuitry, a role whose precise details are as yet unknown and under active investigation. We present the rationale supporting the use of nonmotor STN as a therapeutic target to treat OCD. In particular, we discuss the recent experience and preliminary results of our group after 6 months of nonmotor STN-DBS in patients with severe OCD.

Egas Moniz (1874-1955) and the "invention" of modern psychosurgery: a historical and ethical reanalysis under special consideration of Portuguese original sources

The Portuguese neurologist Egas Moniz (1874-1955) is often regarded as the founder of psychosurgery. He performed the first prefrontal leukotomy in 1935—about 75 years ago—with the help of neurosurgeon Almeida Lima (1903–1985) [corrected]. In contrast to the psychosurgical interventions performed by the Swiss psychiatrist Gottlieb Burckhardt (1836-1907), Moniz's interventions on the white brain substance caught great attention worldwide. As a matter of fact, it was this repercussion that led to the award of the Nobel Prize for Medicine in 1949, an award that is still highly controversial today. The goal of the present article is to reconstruct the historical background of the first leukotomies, the tangible expert debate since 1935 on the indication and legitimacy of these interventions, and their contemporary and recent (ethical) evaluation. Special focus will be set on the original Portuguese literature, which has been given too little attention thus far in the English-language literature.

Telencephalon: Neocortex

The neocortex is an ultracomplex, six-layered structure that develops from the dorsal palliai sector of the telencephalic hemispheres (Figs. 2.24, 2.25, 11.1). All mammals, including monotremes and marsupials, possess a neocortex, but in reptiles, i.e. the ancestors of mammals, only a three-layered neocortical primordium is present [509, 511]. The term neocortex refers to its late phylogenetic appearance, in comparison to the “palaeocortical” olfactory cortex and the “archicortical” hippocampal cortex, both of which are present in all amniotes [509].

Cognitive neuropsychology of alexithymia: implications for personality typology

INTRODUCTION

We examine the cognitive neuroscience of the five components of the alexithymia syndrome, and propose a classification of alexithymia types based on psychobiological traits.

METHOD

Literature review.

RESULTS

The following neural structures have been shown to be prominent in emotional function: right and left hemisphere, corpus callosum, anterior commissure, anterior cingulate, prefrontal cortex, amygdala, and insular cortex. The specific relevance of these structures to alexithymia is discussed.

CONCLUSIONS

The following conclusions and/or propositions are presented: The right hemisphere produces a global, nonverbal overview of emotional information; the left hemisphere seems dedicated to analysing emotions and higher explicit emotional cognitions. Both orbitoprefrontal cortices are important in affective aspects of alexithymia, while right temporal cortex is involved in cognitive aspects. Two subparts of anterior cingulate fulfil functions in the affective and cognitive dimensions of alexithymia. The amygdalae are involved in both cognitive and affective aspects. All structures mentioned can modulate one another. The role of interhemispheric information transfer via the corpus callosum and the anterior commissure is also discussed. The evidence that that cognitive processing of emotional information inhibits affective processing of such information is discussed in terms of its implications for a theory of alexithymia subtypes.

A Neuropsychological and Evolutionary Approach to Animal Consciousness and Animal Suffering

This paper will try to answer the question of whether animals can suffer.

My aim is, firstly, to discuss whether or not an irreflexive animal consciousness could experience suffering. I do this because there are authors who assume such a consciousness in animals. The second part of this contribution concerns the question of the cognitive and neural prerequisites which have to be present in order to give consciousness, or the suffering experience, a positive fitness value. Further, I analyse for which animals these brain structures and cognitive capacities have been described, since consciousness and suffering can only be expected in these animals.

In order to answer the questions, several assumptions had to be made. If the assumptions are correct than the results of the various analyses demonstrate that: i) an irreflexive consciousness is unable to experience suffering; and ii) animal suffering may, for the time being, only be expected in the anthropoid apes. However, there is an important difference between the registration of pain as a stimulus, which does not induce feelings of suffering, and the experience of pain as an emotion, which does induce suffering. According to the arguments presented in this contribution, the experience of pain as a stimulus could be expected in far more species than anthropoid apes alone.

Social and emotional self-regulation

In humans, frontal lesions result in deficits of social and emotional behavior that are often surprising in the presence of intact language and other cognitive skills. The connections between the motivation and memory functions of limbic cortex and the motor planning functions of frontal neocortex must be fundamental to meeting the daily challenges of self-regulation. The connectional architecture of limbic and neocortical networks suggests a model of function. The densely interconnected paralimbic cortices may serve to maintain a global motivational context within which specific actions are articulated and sequenced within frontal neocortical networks. The paralimbic networks represent the visceral and kinesthetic information that is integral to the representation of the bodily self. In a general sense, the implicit self-representation within paralimbic networks may shape the significance of perceptions and the motivational context for developing actions. The network architecture of the frontal lobe reflects the dual limbic origins of frontal cortex, in the dorsal archicortical and ventral paleocortical structures. In this paper, we speculated that these two limbic-cortical pathways apply different motivational biases to direct the frontal lobe representation of working memory. The dorsal limbic mechanisms projecting through the cingulate gyrus may be influenced by hedonic evaluations, social attachments, and they may initiate a mode of motor control that is holistic and impulsive. In contrast, the ventral limbic pathway from the amygdala to orbital frontal cortex may implement a tight, restricted mode of motor control that reflects adaptive constraints of self-preservation. In the human brain, hemispheric specialization appears to have led to asymmetric elaborations of the dorsal and ventral pathways. Understanding the inherent asymmetries of corticolimbic architecture may be important in interpreting the increasing evidence that the left and right frontal lobes contribute differently to normal and pathological forms of self-regulation.