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Neuromodulation Surgery for Psychiatric Disorders

Background

Neuromodulation is a broad term that could technically be considered to cover any medical, surgical, or physiologic therapy designed to alter the function of the nervous system in some manner. In the clinical neurosciences, however, neuromodulation is understood to refer specifically to therapies that involve targeted delivery of drugs or electrical current, frequently through an implanted device, in order to effect a specific change in the function of a target neural structure.

Prior to the development of implantable devices for neurostimulation, surgical procedures designed to alter the function of the nervous system required the destruction of target tissues, with an accompanying irreversible change in function. Neuromodulation, however, provides a paradigm through which therapy can be titrated, or even turned on and off, with changes usually reversing rapidly upon cessation of therapy. While neuromodulation techniques are currently used primarily for the management of chronic pain and movement disorders, there has been considerable interest in their use for medically refractory psychiatric disease. Significant research remains to be done before any of the therapies are likely to become widespread, however. There is also substantial public trepidation about the use of surgical therapies in the treatment of psychiatric disease as a direct consequence of the abuse of psychosurgery in the mid-twentieth century, specifically the heavy human toll exacted by the careless and widespreaduse of the frontal lobotomy.
It is therefore incumbent upon the medical community to ensure that research to refine the effectiveness and expand the indications for neuromodulation in psychiatric disease is conducted in multidisciplinary fashion, and with rigid adherence to the highest standards of medical ethics.

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