Annual Report 2012

AIS Annual Report 2011-12

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1               Activity

1.1.             Summary of activity for year ending May 2012







Vagus Nerve Stimulation



Anterior Cingulotomy






1.2.             Referrals

Forty-five referrals were received during the reporting period (18 men and 27 women); with a mean age of 42.0 years. There were 42 referrals (93.3%) from Scotland, and 3 referrals (6.7%) from England.

1.3.             Assessments

Twenty-six assessments were conducted during the 2011/12 financial year. Twelve men and 14 women were seen, with a mean age of 41.8 years (range 19.3 – 70.3 years). Three 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; this is a similar diagnostic breakdown to previous years. The presence of other diagnoses reflects the complexity and comorbidity of chronic mental illness.

1.4.             Procedures

Three Anterior Cingulotomy procedures were performed during 2011/12. One patient came from England. The service also performed implantation of Deep Brain Stimulation as part of an international research study.

2               Mortality Data & Adverse Effects

There were no deaths and no post-operative infections during the reporting year. Adverse effects are largely unchanged from previous years, and are consistent with the published literature on the procedures undertaken.

3               Waiting Times

The average (±SD) waiting time (from referral to assessment) for Scottish patients was 8.5 ± 5.0 weeks. This is down slightly from the previous year. Ninety-two percent of patients were seen within 18 weeks, with documented reasons for delays for the two patients that waited longer. One was from England, and delays are commonly due to funding approval issues.

4               Quality of Care

4.1.             Formal Complaints

There was one formal complaint which was resolved within the NHS Tayside complaints procedure.

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 6 patients who had undergone Anterior Cingulotomy for depression and were followed up in 2011/12, one met criteria for remission; the patient having maintained this improvement for many years. Two patients who had not met criteria for response still had reductions in their symptom burden.

One patient who underwent Cingulotomy for OCD two years ago continued to experience full clinical remission at follow-up; a status that had been maintained for well over a year.

Of the 3 patients who were reviewed following VNS, one (33%) met criteria for remission. This is consistent with published outcomes in very treatment-refractory patients.

6               Teaching and Research Activities

Members of the team continue to deliver presentations at a regional, national, and international level and publish in peer-reviewed journals in 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. The service is also participating in a novel clinical study of deep brain stimulation for OCD which is funded by the Medical Research Council. Recruitment for this study will open in the third quarter of 2012.

7               Service Developments and Future Plans

The service is participating in an international, multicentre, clinical trial of Deep Brain Stimulation (DBS) for refractory depression. 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.

Following the deliberations and recommendations of the Expert Advisory Group that conducted the 5 year review on behalf of NSD, it has been proposed that the activities of the AIS be formally extended within the SLA to allow inpatient treatment for OCD to be provided in Dundee for patients in NHS Scotland.

8               Summary and Conclusions

Neurosurgical activity in 2011/12 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 remain considerable numbers of patients with unmet needs and we are keen to ensure that they have the opportunity to be referred to the service.