El papel actual de la cirugía del sistema límbico: el caso de la anorexia y la bulimia terminales

Salazar, Manuel Hernández; Méndez, Antonio Zarate; Granados, Francisco Javier Valencia; Luna, Oscar Menéses; Madrigal, Martha Georgina Ochoa; García, Samuel Torres; Silva, Juan Lucino-Castillo Bertín Martínez
March 2009
Archivos de Neurociencias;ene-mar2009, Vol. 14 Issue 1, p11
Academic Journal
Purpose: the psychosurgery or neurosurgery for psychiatric disorders has had a long and controversial history, until the present with contributions from different doctors as the Swiss psychiatrist Gottlieb Burckhart, doctors Egas Moniz. There have been enthusiastic collaborators as well as detractors. The evolution of anesthetic and surgical techniques has given to neurological surgery for psychiatric disorders to be a possible alternative treatment. The most important advances in esterotaxic techniques have been proved to be a safe procedure and with favorable results. Methods: we present three cases of patients with eating disorders; they were presented to a committee of psychosurgery to be evaluated. Zamboni's thalatomy (with bilateral involvement of the lamella medialis) and the limbic leucotomies Kelly's modified. The latter consisting in a combined method in which injuries are performed stereotacticly approximately 6 mm in diameter through cryogenics or thermocoagulation specific targets in 2 points: anterior capsule and cingulum, seeking to disrupt this tract talamocortical (corticostriatalthalamic tract), fibers passing through the arm above the internal capsule (frontal radiation trough thalamus) and connecting with the orbitofrontal cortex and the limbic system bidirectional connections between the frontal lobes (prefrontal areas, limbic circuit) and the prefrontal corticopontine tract. Results: in 12 to 36 months for assessment, we found significant improvement in symptoms related to depression, and disability in the scale of Sheehan, improvement in aggressiveness. Do not have significative (p value) improvement in obsessive-compulsive disorder by the scale of Yale / Brown, anxiety and impulsivity, but they have to statistical tendence to clinical improvement. Conclusions: we have found the association of eating disorders and obsessive-compulsive disorder to improve symptoms OCD patients with eating disorders who have not responded to treatment. This may be an alternative safe and effective.


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