Sympathectomy (ETS) a psychosurgery?

Financial Review - News Store: "It's not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally "colder" than before. Among psychologists and neurologists alike there is concern, but no evidence, that the procedure limits alertness and arousal as well as fear, and might affect memory, empathy and mental performance. Professor Ronald Rapee, the director of the Centre of Emotional Health at Sydney's Macquarie University, says he's counselled several people who complain of feeling "robot-like" in the long-term wake of the operation. "They're happy they no longer blush, but they miss the highs and lows they used to feel.""



'via Blog this'

Dr. Telaranta treating fear, stuttering, stage fright, blushing with sympathectomy. Is ETS a psychosurgery?

Dr. Telaranta | Blog by Dr. Telaranta: "As a treatment, sympathetic blocking could be effective. Fortunately one can test whether it’ll have an effect, to a pretty high level of certainty, by first administering a temporary block t. Sympathetic block is usually effective in reducing all types of fear, why not also in reducing the fear of stuttering.

Sympathetic block typically has the highest likelihood of effective results on both schizophrenia and tremor when fear or anxiety plays a significant part in the onset of symptoms. It is also very effective in treating social phobia, stage fright and blushing. A stage fright-like fear of public presentations is likely common amongst those who stutter."



http://www.sympatix.fi/blog/?lang=en_

Link between skin innervation and neuropathic pain

Nerve conduction studies for large-diameter motor and sensory nerves were normal. This report documents a pure small-fibre sensory neuropathy after prolonged use of linezolid, and the relationship between skin innervation and corresponding neuropathic pain.

Journal of Neurology, Neurosurgery, and Psychiatry 2008;79:97-99

Patients should be clearly warned that TES is not as minor a procedure as usually asserted - The Annals of Thoracic Surgery, 2001

Early complications of thoracic endoscopic sympathectomy: a prospective study of 940 procedures: "Although morbidity was low, significant complications of TES occurred.

Patients should be clearly warned that TES is not as minor a procedure as usually asserted. Complications as well as adverse effects should be considered when discussing this surgical indication."



http://www.sciencedirect.com/science/article/pii/S0003497501024225

The Annals of Thoracic Surgery

Volume 71, Issue 4, April 2001, Pages 1116–1119

Limited sympathectomy does not reduce postoperative compensatory sweating

Endoscopic transthoracic sympathectomy for upper limb hyperhidrosis: Limited sympathectomy does not reduce postoperative compensatory sweating:

http://www.jvascsurg.org/article/S0741-5214(02)75164-1/abstract

"We quickly discovered that lay people often lack the (medical) knowledge to make well-considered judgements"

Jane McCredie: Wishing on risks

MjaInsight Monday, 11 November, 2013

https://www.mja.com.au

Moreover, GPs and plastic surgeons can both be approached directly by patients in The Netherlands. The physicians studied raised many arguments that were expected: they used patient autonomy, risks and benefits, normality and justice to limit wish-fulfilling medicine. In addition, arguments new to this debate were uncovered, which were frequently used to justify compliance with a patient's request. Such arguments seem familiar from conventional medicine, including empathy, the patient–doctor relationship and reassurance. Moreover, certain arguments that play a significant role in the literature on wish-fulfilling medicine and enhancement were not mentioned, such as concepts of disease and the enhancement–treatment dichotomy and ‘suspect norms’.

"We quickly discovered that lay people often lack the (medical) knowledge to make well-considered judgements"

http://jme.bmj.com/content/38/6/327.abstract?sid=c56f1dc3-84aa-4151-bf65-e9fb96268b59

The sympathetic system is responsible for the physiological responses to emotional states

The common epithet of “fight or flight” is being enlarged to be “fight, flight, or fright” or even “fight, flight, fright, or freeze.” Cannon’s original contribution was a catchy phrase to express some of what the nervous system does in response to a threat, but it is incomplete. The sympathetic system is responsible for the physiological responses to emotional states. The name “sympathetic” can be said to mean that (sym- = “together”; -pathos = “pain,” “suffering,” or “emotion”).
http://cnx.org/content/m46582/latest/?collection=col11496/latest

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these ganglia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical interventions 10-14days prior to the nerve lesion with those of chronic administration of adrenoceptor antagonists. Immunohistochemistry was used to define the invading immune cell populations 7days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the relevant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell influx. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflammatory challenge.
Auton Neurosci. 2013 Dec 23.
http://www.ncbi.nlm.nih.gov/pubmed/24418114

Immune cell involvement in dorsal root ganglia and spinal cord after chronic constriction or transection of the rat sciatic nerve.

Hu P, Bembrick AL, Keay KA, McLachlan EM.

Chronic constriction injury (CCI) of the sciatic nerve in rodents produces mechanical and thermal hyperalgesia and is a common model of neuropathic pain. Here we compare the inflammatory responses in L4/5 dorsal root ganglia (DRGs) and spinal segments after CCI with those after transection and ligation at the same site. Expression of ATF3 after one week implied that 75% of sensory and 100% of motor neurones had been axotomized after CCI. Macrophage invasion of DRGs and microglial and astrocytic activation in the spinal cord were qualitatively similar but quantitatively distinct between the lesions. The macrophage and glial reactions around neurone somata in DRGs and ventral horn were slightly greater after transection than CCI while, in the dorsal horn, microglial activation (using markers OX-42(for CD11b) and ED1(for CD68)) was greater after CCI. In DRGs, macrophages positive for OX-42(CD11b), CD4, MHC II and ED1(CD68) more frequently formed perineuronal rings beneath the glial sheath of ATF3+ medium to large neurone somata after CCI. There were more invading MHC II+ macrophages lacking OX-42(CD11b)/CD4/ED1(CD68) after transection. MHC I was expressed in DRGs and in spinal sciatic territories to a similar extent after both lesions. CD8+ T-lymphocytes aggregated to a greater extent both in DRGs and the dorsal horn after CCI, but in the ventral horn after transection. This occurred mainly by migration, additional T-cells being recruited only after CCI. Some of these were probably CD4+. It appears that inflammation of the peripheral nerve trunk after CCI triggers an adaptive immune response not seen after axotomy.

Brain Behav Immun. 2007 Jul;21(5):599-616. Epub 2006 Dec 21.

http://www.ncbi.nlm.nih.gov/pubmed/17187959

Surgical sympathectomy is rarely performed and its use remains controversial

Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.
http://www.ncbi.nlm.nih.gov/pubmed/8370999

Use with caution. The effects of this medicine may be increased after sympathectomy

Sympathectomy (a surgical procedure where certain nerves are removed)—Use with caution. The effects of this medicine may be increased.

http://www.mayoclinic.org/drugs-supplements/bisoprolol-and-hydrochlorothiazide-oral-route/before-using/DRG-20071051

Bisoprolol And Hydrochlorothiazide (Oral Route) - Drugs and Supplements - Mayo Clinic

www.mayoclinic.org

In deciding to use a medicine, the risks of taking the medicine must be weighed 

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic

http://www.mayoclinic.org/documents/mc5520-06pdf/DOC-20077566