Dr. Timo Telaranta is one of the world's leading authorities on sympathetic surgery. He has successfully used various ETS clamping methods to treat social phobia and other mental disorders. These are papers presented to the 4th annual International Symposium of Sympathetic Surgeons, June 2001. Clearly, ETS surgery profoundly affects the human mind, and diminishes the body's response to fear, anxiety, and thrills. As you read the optomistic claims of low side-effects, bear in mind that these patients received very conservative clamping methods, as opposed to the radical ganglionectomy practiced by other ETS surgeons.
Sympathetic surgery for psychiatric problems
Eridd Vaisanen M.D., Ph.D., Paivi Pohjavaara MD, Timo Telaranta M.D., Ph.D.
We need evidence based knowledge about the sympathetic surgery as a treatment method for chronic and severe social phobia. Dr. Tela-ranta has operated many social phobics successfully but our Social Insurance Institution does not accept that method as it reimburses psychotherapies and psychopharmaca. In our study design all patients were first tested by a psychologist. Then the pre- and postoperative interviews were made by a psychiatrist. The total sample now is over one hundred patients. All of them have had many years of different therapies and psychiatric drugs in vain and lost lots of money, too. The operation results are excellent. Only one did not get any relief and in one case the effect came after some months. All the others got immediate help. In our presentation we shall describe some cases.
The connection between psyche and sympathetic nervous system
Timo Telaranta M.D., Ph.D. and Paivi Pohjavaara M.D., Privatix Clinic, Tampere, Finland
In the central nervous system the arousal requires the brain stem, the thalamus and the cortex, attention is maintained in the right frontal lobe; the formation of memories happens in the medial temporal lobe, certain diencephalic nuclei and the basal forebrain. The amygdala rates the emotions of an experience. The limbic system is the centre of the human drives, their regulation requires an intact frontal cortex. The injury in the frontal lobe impairs the executive functions as motivation and attention. The sympathomedullary system and locus coerulaeus are activated in depression, mania, panic disorder and acute phases of schizophrenia. The autonomic nervous system is one of the most important mediators between the mind and the body. It has two roles in this function: the role in basic metabolic function as in energy storage and release, in the control of exocrine secretion and thus intake, in conservation, loss, and transformation of energy the role in behaviour, where the hypothalamus is involved in alert and defense reactions.
The sympathetic system is defined as an energy consumption system and the parasympathetic system is an energy conserving and balancing force. The sympathomedullary system is activated in various mental disorders. The biopsychosocial model is clearly seen in the social phobia. The "fight or flight " response of the sympathetic system can also be seen in the physical signs of the social phobia when the patient is in the centre of attention. With sympathetic overload the patient starts to fear the triggering situations and avoid them. The need-adaptive approach adjusts treatment plans of socially phobic patients who haven't had any help of medication and psychotherapy. It seems possible to treat their symptoms and cut the vicious circle of social phobia blocking the sympathetic system in the upper thoracic level with a surgical procedure. If a patient with the social phobia hasn't had any help of conventional treatment methods such as medication and psychotherapy, the sympathetic block could be a treatment of choice for them
ESB - a new treatment of choice for social phobia?
Pohjavaara P (1,2), Telaranta T(3), Vaisanen E(2); (l) Tampere City Mental Health Care Center, (2) Oulu University Psychiatric Clinic, (3) Privatix Clinic, Tampere, Finland
Social phobia causes in its most severe forms isolation and deteriorates the quality of life. Its life time prevalence rate is as high as about 10% of the population. There are many biological and psychological theories about the etiology of this disorder, however, at least the physical symptoms seem to be mediated through sympathetic nervous system.
The traditional treatment of social phobia consists of medication and/or psychotherapy, and helps about 50-70 % of the patients. An open, uncontrolled prospective follow-up study of 169 patients with the social phobia was carried out. The patients hadn't had help of conservative treatment, they had ESB between the years 1995-2000. The life history was recorded, and they were diagnosed according to DSM IVcriteria. The psychological insecurity in the childhood was more common than other insecurity factors (alcoholism, physical abuse, high religious demands or school torment) at highly significant level. Physical abuse was more common in older age groups statistically.
The mean benefit in the psychic and physical symptoms was about 1,5 points. The wished for effect seemed even to increase over time when the sweating of palms was treated. The only significant side effect, the compensatory sweating of the trunk increased with 0,7 points. The mean satisfaction to the operation was about 3 and it remained the same over time. The quality of life of the operated patients improved. ESB is useful in treatment of social phobia if traditional methods fail. The only meaningful side effect is reflex sweating, but its increase was not statistically significant. The one-sided clamping is as effective a double-sided procedure. The results remain the same over time and thus placebo effect can be excluded. In future it is important to compare this treatment to placebo and traditional treatment to find out its place in the crowd of the other, already officially approved treatment methods of the socialphobia.