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Original research
Lesional psychiatric neurosurgery: meta-analysis of clinical outcomes using a transdiagnostic approach
  1. Benjamin Davidson1,2,3,
  2. David Eapen-John1,2,3,
  3. Karim Mithani1,2,3,
  4. Jennifer S Rabin2,3,4,5,
  5. Ying Meng1,2,3,
  6. Xingshan Cao6,
  7. Christopher B Pople2,3,
  8. Peter Giacobbe2,3,7,
  9. Clement Hamani1,2,3,
  10. Nir Lipsman1,2,3
  1. 1Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  2. 2Harquail Centre for Neuromodulation, Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
  3. 3Sunnybrook Research Institute, Toronto, Ontario, Canada
  4. 4Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
  5. 5Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
  6. 6Research Design and Biostatistics, Sunnybrook Research Institute, Toronto, Ontario, Canada
  7. 7Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  1. Correspondence to Dr Nir Lipsman; Nir.Lipsman{at}sunnybrook.ca

Abstract

Background Four ablative neurosurgical procedures are used in the treatment of refractory psychiatric illness. The long-term effects of these procedures on psychiatric symptoms across disorders has never been synthesised and meta-analysed.

Methods A preregistered systematic review was performed on studies reporting clinical results following ablative psychiatric neurosurgery. Four possible outcome measures were extracted for each study: depression, obsessive–compulsive symptoms, anxiety and clinical global impression. Effect sizes were calculated using Hedge’s g. Equipercentile linking was used to convert symptom scores to a common metric. The main outcome measures were the magnitude of improvement in depression, obsessive compulsive symptoms, anxiety and clinical global impression. The secondary outcome was a subgroup analysis comparing the magnitude of symptom changes between the four procedures.

Results Of 943 articles, 43 studies reporting data from 1414 unique patients, were included for pooled effects estimates with a random-effects meta-analysis. Results showed that there was a large effect size for improvements in depression (g=1.27; p<0.0001), obsessive–compulsive symptoms (g=2.25; p<0.0001) and anxiety (g=1.76; p<0.0001). The pooled clinical global impression improvement score was 2.36 (p<0.0001). On subgroup analysis, there was only a significant degree of heterogeneity in effect sizes between procedure types for anxiety symptoms, with capsulotomy resulting in a greater reduction in anxiety than cingulotomy.

Conclusions Contemporary ablative neurosurgical procedures were significantly associated with improvements in depression, obsessive–compulsive symptoms, anxiety and clinical global impression.

PROSPERO registration number CRD42020164784.

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Any additional materials can be supplied on reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Any additional materials can be supplied on reasonable request.

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Footnotes

  • Contributors BD, DE-J, KM, CH and NL made substantial contributions to the conception and design of this work, as well as the acquisition, analysis, and interpretation of the data. They also played a major role in drafting the work. JR, YM, XC, CBP and PG made substantial contributions acquisition, analysis, and interpretation of the data. All authors granted final approval of the version to be published, and agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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