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Ethics & Guidlines

Surgery for psychiatric disorders has been always disfigured with controversies. In order to avoid the mistakes of the past, psychiatrists from all across India; from (academic and private practice) and functional neurosurgeons met in May 2009. Around 30 experts’s brain stormed and debated over the published literature and evidence. Guidelines for this were subsequently laid down and recommended for any center that desired to follow the surgical program In 2011, World society of stereotactic and functional neurosurgery set up a “Psychiatric surgery task force” to evaluate the evidence and draw guidelines for the psychiatric disorders surgery. After two years of debate and data analysis, the guidelines were formed taking several aspects into consideration and published in 2013. This is an open source publication and can be reviewed by anyone. Some key parts of guidelines are reproduced below:

The scope of neurosurgical intervention for psychiatric disorders

Neurosurgical therapy for psychiatric disorder range from those that have been in routine use in specialist centers for several decades eg: anterior cingulotomy for MDD anterior Capsulotomy for OCD to those that remain highly experimental and have only had been tried very small number of patients eg: (DBS for anorexia nervosa). However, despite the lengthy history and the weight of publications associated with lesion procedures in particular. The collected evidence supporting the application of all neurosurgical treatments for psychiatric disorders requires to be strengthened. While certain procedures are considered to represent ‘established’ practice for severe treatment-refractory psychiatric disorders in some countries (eg: thermal anterior cingulotomy for MDD and OCD in the Scotland, USA, South Korea and elsewhere,  radio-frequency anterior Capsulotomy for severe treatment-refractory OCD in Belgium.) the nature of these & many other procedures in neurosurgery, including DBS for psychiatric disorders, remains at a ‘proof-of-principle’ investigational stage of development. Current practiced stereotactic ablative procedures do not have level I evidence with randomized controlled trials, but their safety and efficacy are supported by level II evidence in treatment-refractory MDD and OCD. However, this degree of evidence is not yet available for ‘new’ lesioning methods such as gamma knife and stereotactic-focused ultrasound.”

The paper goes on to suggest that besides careful patient selection, till the therapies get fully established, they should be overseen by ethics committee or Institutional review board. The guidelines were endorsed by several world organizations, including, European Society for Stereotactic and Functional Neurosurgery (ESSFN), partnering with the Working Group ‘Deep Brain Stimulation in Psychiatry: Guidance for Responsible Research and Application’, along with the Psychiatric Neurosurgery Committee of the American Society for Stereotactic and Functional Neurosurgery (ASSFN), the Latin American Society for Stereotactic and Functional Neurosurgery (SLANFE), the Asian-Australasian Society for Stereotactic and Functional Neurosurgery (AASSFN) and the World Psychiatric Association (WPA).

At the Jaslok Hospital and Research Centre strict adherence is followed. Even before this paper all surgeries were scrutinized and overseen by the Ethics committee and scientific committee of the Jaslok Hospital to ensure patient’s safety.