David Christmas | University of Dundee (original) (raw)

Uploads

Papers by David Christmas

Stereotactic and functional neurosurgery, Jan 16, 2015

The evidence base to guide therapeutic choices for patients with chronic and treatment-refractory... more The evidence base to guide therapeutic choices for patients with chronic and treatment-refractory depression (TRD) remains weak. There is limited comparative information available to guide the choice of intervention for patients with the most severe and disabling forms of illness. The aim of this work was to describe the 12-month clinical outcomes of patients with chronic TRD treated with anterior capsulotomy (ACAPS; n = 5), anterior cingulotomy (ACING; n = 5) or vagus nerve stimulation (VNS; n = 5). We performed a retrospective, consecutive, case series comparison. With clinical response defined as a ≥50% reduction from the baseline MADRS score, response rates were 40% for ACAPS, 60% for ACING and 20% for VNS. Adverse effects from all three procedures were relatively mild, consistent with previous reports and, in most cases, transient. Adverse effects from VNS were related to active stimulation, and were modifiable and diminished in severity over time. There were no deaths. Althoug...

Psychiatric Bulletin, 2005

The Psychiatrist. Skip to main page content. ...

Journal of Clinical Psychopharmacology, 2010

Biological Psychiatry, 2008

Anterior cingulotomy (ACING) is a neurosurgical treatment for chronic refractory depression, pain... more Anterior cingulotomy (ACING) is a neurosurgical treatment for chronic refractory depression, pain, and obsessive-compulsive disorder. Anterior cingulotomy involves the placement of bilateral lesions in the anterior cingulate under stereotactic guidance. Although a long-established therapeutic intervention, the optimal location and volume of lesions are not known, but it is generally believed that efficacious lesions interrupt the fibers of the cingulum bundle. Using T2-weighted magnetic resonance imaging, we tested the hypothesis that lesions placed more anteriorly would be associated with a better clinical response. We also tested a secondary hypothesis that a superior clinical response would be associated with larger lesion volumes. When assessed 12 months following surgery, a superior clinical response was associated with more anterior lesions but, unexpectedly, with smaller lesion volumes. Specifically, the best clinical response was associated with total (right plus left hemisphere) lesion volumes of 1000 to 2000 mm(3) centered at Montreal Neurological Institute (MNI) coordinates (+/- 9,19,30). There is considerable evidence from neuroimaging studies that more rostral areas within the anterior cingulate cortex are functionally and structurally abnormal in patients with major depressive disorder. Anteriorly placed ACING lesions would target and modify function within such regions. It should not be assumed that larger lesions are associated with a better response. These findings of relationships between lesion characteristics and clinical response argue against the suggestion that ACING represents a placebo treatment.

Psychological Medicine, 2008

British Journal of Psychiatry, 2004

Neuroscience and Biobehavioral Reviews, 2005

Psychiatry, 2009

Advanced treatment options are available from a few tertiary centres for those patients with the ... more Advanced treatment options are available from a few tertiary centres for those patients with the most severe and treatment-refractory forms of depression and obsessive compulsive disorder. These treatments include ablative neurosurgery and electrical stimulation procedures directed against different neural targets. These include vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Ablative procedures, such as anterior cingulotomy, are the best established of these alternatives, although the newer electrical stimulation procedures confer potential advantages with respect to surgical morbidity and reversibility. Both VNS and DBS should be considered as experimental therapies, with definitive evidence of efficacy not yet available. All neurosurgical procedures used to treat psychiatric disorder should be provided by specialized multidisciplinary teams with expertise in the management of psychiatric disorder by pharmacological and psychological treatment methods. All psychiatric neurosurgical procedures should be subject to detailed long-term clinical audit to determine efficacy and adverse effect burden.

Journal of Affective Disorders, 2011

Psychiatry, 2006

Advanced treatment options are available from a few tertiary centres for those patients with the ... more Advanced treatment options are available from a few tertiary centres for those patients with the most severe and treatment-refractory forms of depression and obsessive compulsive disorder. These treatments include ablative neurosurgery and electrical stimulation procedures directed against different neural targets. These include vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Ablative procedures, such as anterior cingulotomy, are the best established of these alternatives, although the newer electrical stimulation procedures confer potential advantages with respect to surgical morbidity and reversibility. Both VNS and DBS should be considered as experimental therapies, with definitive evidence of efficacy not yet available. All neurosurgical procedures used to treat psychiatric disorder should be provided by specialized multidisciplinary teams with expertise in the management of psychiatric disorder by pharmacological and psychological treatment methods. All psychiatric neurosurgical procedures should be subject to detailed long-term clinical audit to determine efficacy and adverse effect burden.

Stereotactic and functional neurosurgery, Jan 16, 2015

The evidence base to guide therapeutic choices for patients with chronic and treatment-refractory... more The evidence base to guide therapeutic choices for patients with chronic and treatment-refractory depression (TRD) remains weak. There is limited comparative information available to guide the choice of intervention for patients with the most severe and disabling forms of illness. The aim of this work was to describe the 12-month clinical outcomes of patients with chronic TRD treated with anterior capsulotomy (ACAPS; n = 5), anterior cingulotomy (ACING; n = 5) or vagus nerve stimulation (VNS; n = 5). We performed a retrospective, consecutive, case series comparison. With clinical response defined as a ≥50% reduction from the baseline MADRS score, response rates were 40% for ACAPS, 60% for ACING and 20% for VNS. Adverse effects from all three procedures were relatively mild, consistent with previous reports and, in most cases, transient. Adverse effects from VNS were related to active stimulation, and were modifiable and diminished in severity over time. There were no deaths. Althoug...

Psychiatric Bulletin, 2005

The Psychiatrist. Skip to main page content. ...

Journal of Clinical Psychopharmacology, 2010

Biological Psychiatry, 2008

Anterior cingulotomy (ACING) is a neurosurgical treatment for chronic refractory depression, pain... more Anterior cingulotomy (ACING) is a neurosurgical treatment for chronic refractory depression, pain, and obsessive-compulsive disorder. Anterior cingulotomy involves the placement of bilateral lesions in the anterior cingulate under stereotactic guidance. Although a long-established therapeutic intervention, the optimal location and volume of lesions are not known, but it is generally believed that efficacious lesions interrupt the fibers of the cingulum bundle. Using T2-weighted magnetic resonance imaging, we tested the hypothesis that lesions placed more anteriorly would be associated with a better clinical response. We also tested a secondary hypothesis that a superior clinical response would be associated with larger lesion volumes. When assessed 12 months following surgery, a superior clinical response was associated with more anterior lesions but, unexpectedly, with smaller lesion volumes. Specifically, the best clinical response was associated with total (right plus left hemisphere) lesion volumes of 1000 to 2000 mm(3) centered at Montreal Neurological Institute (MNI) coordinates (+/- 9,19,30). There is considerable evidence from neuroimaging studies that more rostral areas within the anterior cingulate cortex are functionally and structurally abnormal in patients with major depressive disorder. Anteriorly placed ACING lesions would target and modify function within such regions. It should not be assumed that larger lesions are associated with a better response. These findings of relationships between lesion characteristics and clinical response argue against the suggestion that ACING represents a placebo treatment.

Psychological Medicine, 2008

British Journal of Psychiatry, 2004

Neuroscience and Biobehavioral Reviews, 2005

Psychiatry, 2009

Advanced treatment options are available from a few tertiary centres for those patients with the ... more Advanced treatment options are available from a few tertiary centres for those patients with the most severe and treatment-refractory forms of depression and obsessive compulsive disorder. These treatments include ablative neurosurgery and electrical stimulation procedures directed against different neural targets. These include vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Ablative procedures, such as anterior cingulotomy, are the best established of these alternatives, although the newer electrical stimulation procedures confer potential advantages with respect to surgical morbidity and reversibility. Both VNS and DBS should be considered as experimental therapies, with definitive evidence of efficacy not yet available. All neurosurgical procedures used to treat psychiatric disorder should be provided by specialized multidisciplinary teams with expertise in the management of psychiatric disorder by pharmacological and psychological treatment methods. All psychiatric neurosurgical procedures should be subject to detailed long-term clinical audit to determine efficacy and adverse effect burden.

Journal of Affective Disorders, 2011

Psychiatry, 2006

Advanced treatment options are available from a few tertiary centres for those patients with the ... more Advanced treatment options are available from a few tertiary centres for those patients with the most severe and treatment-refractory forms of depression and obsessive compulsive disorder. These treatments include ablative neurosurgery and electrical stimulation procedures directed against different neural targets. These include vagus nerve stimulation (VNS) and deep brain stimulation (DBS). Ablative procedures, such as anterior cingulotomy, are the best established of these alternatives, although the newer electrical stimulation procedures confer potential advantages with respect to surgical morbidity and reversibility. Both VNS and DBS should be considered as experimental therapies, with definitive evidence of efficacy not yet available. All neurosurgical procedures used to treat psychiatric disorder should be provided by specialized multidisciplinary teams with expertise in the management of psychiatric disorder by pharmacological and psychological treatment methods. All psychiatric neurosurgical procedures should be subject to detailed long-term clinical audit to determine efficacy and adverse effect burden.