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In 1949, António Egas Moniz won the Nobel Prize for the prefrontal lobotomy, but after indiscriminate use of transorbital lobotomy and the advent of modern psychopharmacology, the popularity of lobotomy waned. Today, interest has rekindled in safer and more precise neurosurgical procedures, especially for patients with drug-refractory disease.
FDA approval of vagus nerve stimulation (VNS) for refractory depression was based on two related manufacturer-sponsored studies. VNS showed no advantage over sham VNS in the first 3 months, but in an open-label follow-up of 205 subjects, 27% responded and 16% remitted at 1 year. By 24 months, most initial responders still met response criteria, with similar rates in bipolar and uni…