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Article Dans Une Revue Journal of Neurology, Neurosurgery and Psychiatry Année : 2010

Long-Term Outcome of Thermal Anterior Capsulotomy for Chronic, Treatment-Refractory Depression

David M. B. Christmas
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M. Sam Eljamel
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Sharon Butler
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Hiral Hazari
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Robert Macvicar
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Douglas Steele
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Alison Livingstone
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Keith Matthews
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Résumé

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. Whilst 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. Method: A prospective case series of 20 patients treated by 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 magnetic resonance imaging was performed in 14 participants. Results: According to a priori criteria, at long-term follow-up, 50% were classified as 'responders', 40% as 'remitters'. Fifty-five percent 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.
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Dates et versions

hal-00600451 , version 1 (15-06-2011)

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David M. B. Christmas, M. Sam Eljamel, Sharon Butler, Hiral Hazari, Robert Macvicar, et al.. Long-Term Outcome of Thermal Anterior Capsulotomy for Chronic, Treatment-Refractory Depression. Journal of Neurology, Neurosurgery and Psychiatry, 2010, 82 (6), pp.594. ⟨10.1136/jnnp.2010.217901⟩. ⟨hal-00600451⟩

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