Answer to the Comment by Lévêque et al. on ‘Bilateral Cingulotomy and Anterior Capsulotomy Applied to Patients with Aggressiveness'

(3) The first series was followed up for 6 months and the second series for 4 years. According to the points below, the following information should be considered: (A) There are no patients omitted in the series because they are different. (B) Four patients were involved in both series and they were evaluated by the Mayo-Portland Adaptability Inventory and the Overt Aggression Scale. They were followed up for 6 months and 4 years. The first paper was published in March/April 2011, i.e. during the period of evaluation of the second paper (from July 2010 to May 2011). (C) Side effects are not the same because they came from different series. Of course, we can observe a similarity between the two because the same procedure was used. (D) The image of capsulotomy shows a representative lesion of fibers in the internal capsule and some part of the striatum is involved in this area. Although, the main target of the leucotomy is in the anterior limb of the internal capsule. That observation suggests another small series only with anterior capsulotomy that has not been published. We present here two different slices of axial MRI where bilateral anterior capsulotomy is shown at the 4-year follow-up ( fig. 1 ). We appreciate a lot the interest in our paper ‘Bilateral cingulotomy and anterior capsulotomy applied to patients with aggressiveness’ published in Stereotactic and Functional Neurosurgery [1] . However, Lévêque et al. wrote the title as ‘Bilateral anterior capsulotomy and cingulotomy applied to patients with aggressiveness’ [2] . We think that mistake could be caused by the special interest in the effect of capsulotomy. We have read all the issues by Lévêque et al. in order to try answering. We have published a very similar series of cases entitled ‘Evaluación de la cingulotomía bilateral y la capsulotomía anterior en el tratamiento de la agresividad’ [3] in 2011. This paper involved similar patients with aggressiveness because the Unit of Stereotactic, Functional Neurosurgery and Radiosurgery has attended this kind of cases since 1994. Both series correspond to a bigger cohort that included around 36 patients. Initially, we had to elaborate a scientific and ethical process to diagnose and propound a method of treatment for these subjects. In the first series reported [3] , 12 patients underwent bilateral anterior capsulotomy and cingulotomy and were evaluated by the Mayo-Portland Adaptability Inventory and Global Assessment Functioning Scale because those were the accessible instruments at that moment. A year later, a second series [1] was treated with the same surgery procedure but studied by the Overt Aggression Scale and Global Assessment of Functioning Scale. Those series have 4 cases in common (No. 1, 5, 7 and 8 from the second series). We must state several differences between them: (1) The first series was followed up for only 6 months owing to the fact that the patients came from different states of Mexico and from the metropolitan area. Those of the second series came mainly from the metropolitan area. (2) The first series was evaluated in the follow-up period by 3 psychiatrists; they applied the Mayo-Portland Adaptability Inventory. The second series was evaluated only by a single psychiatrist (J.J. Bustamante) who applied the Overt Aggression Scale. Received: September 15, 2012 Accepted: October 17, 2012 Published online: February 27, 2013