Annual Report 2011

AIS Annual Report 2010-11

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1               Activity








Vagus Nerve Stimulation



Anterior Cingulotomy







1.1.             Referrals

Forty-one referrals were received during the reporting period (16 men and 26 women); with a mean age of 48.5 years. This is a similar demographic to previous years. There were 37 referrals (87.8%) from Scotland, 4 referrals (9.8%) from England, and 1 referral (2.4%) from Northern Ireland.

1.2.             Assessments

Twenty-seven assessments were conducted during the 2010/11 financial year. Seventeen men and 10 women were seen, with a mean age of 47.9 years (range 26.1 – 69.1 years). Five assessments were conducted outwith the SLA.

Approximately 50% of patients had a diagnosis of unipolar major depression, and approximately 30% of patients had a primary diagnosis of obsessive-compulsive disorder; up from 20% last year.

1.3.             Procedures

Six Anterior Cingulotomy procedures and one VNS implantation were performed during 2010/11. Four patients came from England.

2               Mortality Data & Adverse Effects

There were no deaths and no post-operative infections during the reporting year. One individual had a small post-operative haemorrhage which had no clinically-detectable effects and was only seen on MRI scan. One patient experienced non-stimulation-related voice alteration following implantation of a VNS stimulator – this is expected to resolve.

3               Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.6 ± 3.7 weeks. This is similar to the previous year. Where patients had to wait longer than 15 weeks, this could be accounted for by reasons such as delays in receiving formal confirmation of funding (for English patients) and delays in the service being sent clinical case notes which are necessary for assessment.

4               Quality of Care

4.1.             Formal Complaints

There were no formal complaints.

4.2.             Improving the Patient Experience – Patient Satisfaction

Patient satisfaction for outpatient assessment and inpatient admission continues to be high, with the overwhelming majority reporting positive experiences of the service.

5               Best Value Healthcare – Clinical Audit and Outcomes

5.1.             Outcome Data

Of the 2 patients who had undergone Anterior Cingulotomy for depression and were followed up in 2010/11, one met criteria for response, although none met criteria for remission (categories not mutually exclusive). The majority of patients undergoing ablative neurosurgery experienced reductions in symptoms ranging from 19% to 50%. One patient underwent cingulotomy for OCD and experienced full clinical remission one year after surgery.

Of the 6 patients who were reviewed following VNS, three met criteria for response. One met criteria for remission.

6               Teaching and Research Activities

Members of the team continue to deliver presentations at a regional, national, and international level. Staff continue to publish in peer-reviewed journals on fields such as: neurosurgery; ablative neurosurgery; vagus nerve stimulation; neuroimaging; and neuropsychology.

The service is research active, with a range of active research projects, some of which are part of international, multi-centre clinical trials of neuromodulation for depression.

7               Service Developments and Future Plans

The service is participating in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression, and has currently enrolled the first participant. This will enable us to not only advance treatments in this refractory population but also to develop patient choice in this clinical area. Uniquely, in Dundee, we will have the opportunity to evaluate the outcomes for DBS alongside those for other neurosurgical therapies.

8               Summary and Conclusions

Neurosurgical activity in 2010/11 continues to be variable but it is recognised that clinical activity varies from one year to the next and is dependent upon the nature of the patients referred. We believe that there are considerable numbers of patients with unmet needs and we are keen to ensure that they have the opportunity to be referred to the service.