Editing Bilateral cingulotomy (section)

== Target ==
Bilateral cingulotomy targets the [[anterior cingulate cortex]], which is a part of the [[limbic system]]. This system is responsible for the integration of feelings and emotion in the human [[cortex (anatomy)|cortex]]. It consists of the [[cingulate gyrus]], [[parahippocampal gyrus]], [[amygdala]], and the [[hippocampal formation]].<ref name="Kandel">Kandel E., Schwartz J., Jessel T., .. (2000). Principles of Neural Science.4th edition, McGraw-Hill, New York, 853-857.</ref>

Studies in patients who were subject to bilateral cingulotomy, involving [[fMRI]] analyses, showed that the anterior cingulate cortex has a key role in [[cognitive]] control and is highly likely to be involved in the control of attentional response, whereas the [[Anatomical terms of location#Dorsal and ventral|dorsal]] part of that region of the brain was not identified to be involved in such a process, although this is still under dispute.<ref name=" Davis">{{cite journal | pmid = 10848573| year = 2000| last1 = Davis| first1 = K. D.| last2 = Hutchison| first2 = W. D.| last3 = Lozano| first3 = A. M.| last4 = Tasker| first4 = R. R.| last5 = Dostrovsky| first5 = J. O.| title = Human anterior cingulate cortex neurons modulated by attention-demanding tasks| journal = Journal of Neurophysiology| volume = 83| issue = 6| pages = 3575–3577| doi = 10.1152/jn.2000.83.6.3575| s2cid = 2305149}}</ref> The function of the dorsal part of the cingulate cortex was connected to the sorting out and processing of conflicting information signals. In addition, [[neuroimaging]] studies also indicated that the anterior cingulate cortex participates in the modulation of [[Cerebral cortex|cortical]] regions that are of higher order, as well as sensory processing areas.<ref name=" Menon">{{cite journal | pmid = 16768376| year = 2006| last1 = Crottaz-Herbette| first1 = S.| last2 = Menon| first2 = V.| title = Where and when the anterior cingulate cortex modulates attentional response: Combined fMRI and ERP evidence| journal = Journal of Cognitive Neuroscience| volume = 18| issue = 5| pages = 766–780| doi = 10.1162/jocn.2006.18.5.766| s2cid = 17231967}}</ref>

These findings have also been confirmed by [[stereotactic]] [[microelectrode]] analysis of single cortical [[neurons]] in a study, which involved nine patients undergoing bilateral cingulotomy.<ref name="Davis"/> The study investigated the effect of performing attention demanding tasks on the activity of 36 neurons located in the anterior cingulate cortex. Upon analyzing the results of the study, it was concluded that the anterior cingulate cortex is indeed involved in the modification of [[cognitive]] tasks that require attention, based on the fact that there was a change in the basal firing rate of neurons in that region during simulation of such tasks.<ref name="Davis"/>

Neuroimaging also uncovered different sub-regions in the anterior cingulate cortex itself, based on their function. These studies showed that the [[Caudal (anatomical term)|caudal]] part of the anterior cingulate cortex plays a more important function in cognitive activities that involve attention, salience, interference and response competition.<ref name="Menon"/> These results, combined with [[electrophysiological]] investigation of the function of neurons in the anterior cingulate cortex, have provided insights that can be used in the improvement of cingulotomy performed on patients treated for [[obsessive–compulsive disorder]] (OCD). The basis behind this idea is the fact that a variation of certain tasks, [[Stroop effect|emotional Stroop task]]s (ES), which have been particularly identified as exerting effects in OCD patients, activate neurons in the more [[Anatomical terms of location#Anterior and posterior|rostral]] part of the anterior cingulate cortex. Thus, theoretically, if bilateral cingulotomy is performed in such a patient in the rostral anterior cingulate cortex, better results should be obtained.<ref name="Davis"/><ref name="Menon"/>

Moreover, OCD has been associated with a malformation of the [[basal ganglia]].<ref name="Jessel">Kandel E., Schwartz J., Jessel T., .. (2000). Principles of Neural Science.4th edition, McGraw-Hill, New York, 1223-1224.</ref> The function of this part of the human brain has been mapped to be composed of fiber tracks associated with numerous parallel cortico-striato-thalamocortical circuits (CSTC), which are involved in sensorimotor, [[motor system|motor]], [[oculomotor]] as well as the [[cognitive]] processes that are manifested by the [[limbic system]].<ref name=" Leckman ">Leckman. (2000). Tic Disorder.  Neuropsychopharmacology: The Fifth Generation of Progress</ref> This pathway involves [[GABAergic]] [[inhibitory]] projections that serve as one of the means of communication between the different structures involved.<ref name="Jessel"/><ref name="Leckman"/> It has been hypothesized that some forms of OCD are a result of disinhibition of one or several of the circuits that operate in the CSTC.<ref name="Leckman"/>  This is also indicated by a finding that showed a significant decrease in intracortical [[:wikt:inhibit|inhibition]] in OCD patients.<ref name=" Greenberg">{{cite journal | pmid = 10636140| year = 2000| last1 = Greenberg| first1 = B. D.| last2 = Ziemann| first2 = U.| last3 = Corá-Locatelli| first3 = G.| last4 = Harmon| first4 = A.| last5 = Murphy| first5 = D. L.| last6 = Keel| first6 = J. C.| last7 = Wassermann| first7 = E. M.| title = Altered cortical excitability in obsessive-compulsive disorder| journal = Neurology| volume = 54| issue = 1| pages = 142–147| doi = 10.1212/wnl.54.1.142| s2cid = 44408152}}</ref> Thus, [[lesions]] in the anterior cingulate cortex might contribute to the lessening of the disinhibition effect. This hypothesis has been confirmed by another study, which assessed the [[Cerebral cortex|cortical]] inhibitory and excitatory mechanisms in OCD.<ref name=" Greenberg"/> The study measured the excitability of the [[motor cortex]], as well as intracortical inhibition in OCD patients and a control group of healthy individuals.<ref name="Greenberg"/> The results showed a significant decrease in intracortical inhibition, which resulted in a slowdown of [[interstimulus interval]]s by 3&nbsp;ms.<ref name="Greenberg"/> In addition to its proximity to and association with the limbic system and the [[amygdala]] in particular, which plays a key role in emotional experience, the anterior cingulate cortex shares [[afferent nerve fiber|afferent]] and [[efferent nerve fiber|efferent]] pathways with a number of [[thalamic nuclei]] as well as the [[posterior cingulate]] and part of some [[parietal lobe|parietal]], [[frontal lobe|frontal]] and [[supplementary motor cortex]].<ref name=" Cohen">{{cite journal | pmid = 10570756| year = 1999| last1 = Cohen| first1 = R. A.| last2 = Kaplan| first2 = R. F.| last3 = Zuffante| first3 = P.| last4 = Moser| first4 = D. J.| last5 = Jenkins| first5 = M. A.| last6 = Salloway| first6 = S.| last7 = Wilkinson| first7 = H.| title = Alteration of intention and self-initiated action associated with bilateral anterior cingulotomy| journal = The Journal of Neuropsychiatry and Clinical Neurosciences| volume = 11| issue = 4| pages = 444–453| doi = 10.1176/jnp.11.4.444}}</ref> All these underline the high likelihood that the anterior cingulate cortex must have some involvement in OCD.

Functional [[MRI]] analyses of the anterior cingulate cortex have also led to the introduction of bilateral cingulotomy for the treatment of [[chronic pain]]. Such application was introduced since the anterior cingulate cortex has been found to be related to the processing of [[nociceptive]] information input. In particular, the role of the anterior cingulate cortex is in the interpretation of how a [[Stimulus (physiology)|stimulus]] affects a person rather than its actual physical intensity.<ref name=" Lenz">{{cite journal | pmid = 9772262| year = 1998| last1 = Lenz| first1 = F. A.| last2 = Rios| first2 = M.| last3 = Chau| first3 = D.| last4 = Krauss| first4 = G. L.| last5 = Zirh| first5 = T. A.| last6 = Lesser| first6 = R. P.| title = Painful stimuli evoke potentials recorded from the parasylvian cortex in humans| journal = Journal of Neurophysiology| volume = 80| issue = 4| pages = 2077–2088| doi = 10.1152/jn.1998.80.4.2077}}</ref><ref name=" Rolls">{{cite journal | pmid = 12571120| year = 2003| last1 = Rolls| first1 = E. T.| last2 = O'Doherty| first2 = J.| last3 = Kringelbach| first3 = M. L.| last4 = Francis| first4 = S.| last5 = Bowtell| first5 = R.| last6 = McGlone| first6 = F.| title = Representations of pleasant and painful touch in the human orbitofrontal and cingulate cortices| journal = Cerebral Cortex | volume = 13| issue = 3| pages = 308–317| doi = 10.1093/cercor/13.3.308| doi-access = }}</ref>