Status of neurosurgery for mental disorder in Scotland. Selective literature review and overview of current clinical activity.

BACKGROUND: Despite the application of ablative neurosurgical treatments for intractable mental disorder throughout most of the past century, unequivocal evidence for efficacy has not been provided. AIMS: To review the status of ablative neurosurgery for mental disorder and to describe the activities of the Scottish national service.
METHOD: Relevant literature is reviewed alongside a description of recent clinical activity.
RESULTS: Neurosurgical treatment is offered to a small number of patients severely disabled by otherwise intractable mental disorder. There are inequalities in the strength of evidence to support the use of some of these procedures. The frequency and severity of adverse effects remains unclear. We are collecting data that should inform future practice.
CONCLUSIONS: Modern neurosurgery can offer clinically meaningful symptom relief and improved function for 'untreatable' patients with chronic, severe depression and obsessive-compulsive disorder. However, follow-up studies of greater rigour are required. The potential role of non-ablative alternatives remains unclear.