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Abnormalities of Smell
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
Richard L. Doty, Steven M. Bromley
Sensorineural impairment of olfaction is typically more difficult to manage, and the prognosis for patients suffering from long-standing total loss due to upper respiratory illness or head trauma is poor. The majority of patients who recover smell function subsequent to trauma do so within 12 weeks of injury.35 Patients who quit smoking typically have dose-related improvement in olfactory function and flavour sensation over time.25 Central lesions, such as CNS tumours that impinge on olfactory bulbs and tracts can often be resected with significant improvement in olfactory function. When epilepsy or migraine is suspected, a course of anti-epileptic or anti-migraine medications might prove beneficial. Medically-refractory epilepsy resulting in olfactory disturbance can be successfully treated with surgery. For example, Chitanondh59 reported successful treatment of 7 patients with seizure disorder, olfactory hallucinations, and psychiatric problems by stereotactic amygdalotomy, concluding ‘stereotactic amygdalotomy has a dramatic effect on olfactory seizures, auras, and hallucinations. It is a safe surgical procedure and can be done without neurological deficit’. In patients with multiple sclerosis, immunomodulatory therapies, including interferon beta and occasional steroids, is the mainstay of treatment. When depression or psychosis is suspected, a course of an anti-depressant and appropriate psychiatric referral may be necessary.
Imaging procedures in understanding brain injury
Published in Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose, Surviving Brain Damage After Assault, 2016
Barbara A. Wilson, Samira Kashinath Dhamapurkar, Anita Rose
In 1998, Pizzamiglio and associates used functional imaging to monitor the effects of rehabilitation for unilateral neglect. The brain regions most active after recovery were almost identical to the areas active in control participants engaged in the same tasks. This would appear to support the view that some rehabilitation methods repair the lesioned network and do not simply work through compensation or behavioural change.Jang and colleagues (2007) scanned a 25-year-old man who received comprehensive neurorehabilitation for significant problems associated with right hippocampal sclerosis, temporal lobectomy and amygdalotomy. He had 8 months of treatment, mainly for motor problems. Motor tests and fMRI were used to determine the restoration of motor function and neuro-plastic changes. The motor tests showed that the man had improved on functional reaching, grasping and hand manipulation skills. He maintained this improvement at a 6-month follow-up. An fMRI showed that before treatment, there was asymmetry of the contralesional sensori-motor cortex activation, and this was restored to normal symmetry after rehabilitation. This suggests that comprehensive neurorehabilitation may facilitate restitution of normal symmetry of cortical activation, thereby enhancing motor function. Baxter (2007) described a patient with limbic encephalitis who had severe antero-grade amnesia with subsequent recovery. They used fMRI to show increased hippocampal activation before and after recovery.Scholz and associates (2009) found that training a complex visuo-spatial skill led to changes in white matter, while Thaut and McIntosh (2010) showed that music therapy led to changes in the brain as measured by brain imaging techniques. In the words of Wilde, Hunter and Bigler (2012), “Neuroimaging methods also provide insights into the complexities of brain injury, cognitive and neurobehavioural recovery” (p. 245).
Ablative brain surgery: an overview
Published in International Journal of Hyperthermia, 2019
Andrea Franzini, Shayan Moosa, Domenico Servello, Isabella Small, Francesco DiMeco, Zhiyuan Xu, William Jeffrey Elias, Angelo Franzini, Francesco Prada
Patients selected for hypothalamotomy or amygdalotomy were usually cognitively impaired and had low IQ, even though patients without cognitive deficits were treated as well [100]. The procedures were performed bilaterally in staged or single sessions, and they could be combined in refractory patients [100]. Ramamurthi et al. reported on a series of 603 patients with aggressive behavior disorder who were treated with stereotactic amygdalotomies and hypothalamotomies. Success was sustained in 70% of patients at three years, with no deterioration in IQ or behavior [100]. Likewise, Sano published a series of 37 patients undergoing hypothalamotomy for aggressive behavior. The results were considered to be satisfactory in 29 cases (78%) and were stable after a 10-year follow-up period. Several other smaller series of patients have been treated with hypothalamotomy and amygdalotomy, with satisfactory clinical improvement in 80% or more of patients [98]. However, all these series lack detailed information on their measuring instruments, reporting of side effects, and stringent monitoring by an ethics committee. These requirements were met by a recent study on bilateral combined AC and ACT, which reported a significant reduction of aggressiveness and improvement in social and family relationships in 10 patients [101].
Unilateral amygdala ablation: a potential treatment option for severe chronic post-traumatic stress disorder (PTSD)?
Published in Expert Review of Neurotherapeutics, 2023
Lois Teye-Botchway, Jon T. Willie, Sanne J.H. van Rooij
Our published results to date, while suggestive, are nevertheless preliminary. First, we made observations only in patients suffering from both right medial temporal lobe epilepsy and PTSD, which may undermine the generalizability to patients with PTSD alone. Second, we observed the effects of combined right amygdala and anterior hippocampus ablation. While the amygdala has been directly implicated in PTSD by other studies, lending face validity to the amygdala’s causal role, our preliminary results do not formally dissect the benefits of isolated amygdala ablation. Third, there are case reports suggesting development or worsening of PTSD symptoms after left amygdala-hippocampectomy [11] or left amygdalotomy [12], as well as a case report of development of PTSD after right temporal lobe ablation that included the right amygdala, hippocampus and temporal pole [13], which suggests that specificity of hemisphere and regions for ablation is critical and warrants further investigation. Fourth, our small, open-label, uncontrolled, prospective, observational case series does not constitute a formal clinical trial of a design that would maximize the quality of the results. Randomized controlled trials (RCT) comparing the safety and effectiveness of the investigation intervention to standard of care therapy (medication and cognitive-behavioral therapy), and ideally utilizing blinding and even sham surgery control (when ethical to perform a sham surgery and feasible), are the preferred approach. While the necessity of alternative clinical trial designs for novel surgical therapies is increasingly recognized, the fraught history of psychosurgery in the middle of the last century demands the highest level of attention to ethical oversight to guarantee informed consent and appropriate trial design for surgery for psychiatric indications.