- Department of Neurosurgery, University of Baghdad, College of Medicine, Baghdad, Iraq,
- Department of Neurosurgery, University of Washington, Seattle, Washington,
- Department of Neurosurgery, University of Louisville, Kentucky,
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States.
Samer S. Hoz, Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, United States.
DOI:10.25259/SNI_830_2022Copyright: © 2022 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Ismail M1, Aljuboori Z2, Muthana A1, Sharma M3, Hoz SS4, Andaluz N4. The next bet for cerebral aneurysms treatment: Psychedelics. Surg Neurol Int 30-Sep-2022;13:451
How to cite this URL: Ismail M1, Aljuboori Z2, Muthana A1, Sharma M3, Hoz SS4, Andaluz N4. The next bet for cerebral aneurysms treatment: Psychedelics. Surg Neurol Int 30-Sep-2022;13:451. Available from: https://surgicalneurologyint.com/surgicalint-articles/11899/
Years of stigma have impeded study into the medicinal benefits of psychedelic substances, despite their widespread use for millennia.[
The most extensively researched and culturally relevant psychedelics, including lysergic acid diethylamide (LSD), mescaline, psilocybin, and dimethyltryptamine, are considered “classical” psychedelics. Despite having a wide variety of molecular structures and targeted receptors, psychedelics share the ability to induce profound changes in consciousness, sensory perception, sense of time distortion, and reality perception. There is an evidence that stimulation of 5-HT2A receptors (a class of serotonin receptors) is the major mechanism underlying the psychological experience of these psychedelics and the anti-inflammatory action. However, these substances are known to operate at different receptors. In neuroscience and neurosurgery, psychedelics have been investigated to have a role in neuroplasticity, memory, brain injury, and neuroinflammation.[
The formation of intracranial aneurysms and their tendency to rupture is of clinical importance. Observation, along with expectant management, microsurgical clipping, and/or endovascular coiling are the current modes of management. Despite technological advancements, surgical procedures are invasive and linked to considerable risk of complications. However, recent investigations on humans and animals indicate that inflammation plays a crucial role in aneurysm development and progression to rupture. The modulation of this inflammatory process may have clinical relevance.[
Psychedelics promote their anti-inflammatory functions by activating the serotonin 5-HT2A receptor. 5-HT2A is the most abundant serotonin receptor in the body. It’s on basically all tissues and cell types, including immune-related types, and the brain has most 5-HT2A receptors.[
In contrast to steroids, which induce widespread systemic immunosuppression, psychedelics induce an anti-allergic pattern of cytokine production.[
Preliminary research has shown that psychedelics, including LSD, inhibited inflammation induced by the master inflammatory cytokine tumor necrosis factor-alpha (TNF-α) in smooth muscle cells taken from rat aorta.[
Hemodynamic stress and inflammation play an essential role in forming intracranial aneurysms. Inflammation is also associated with aneurysmal growth and subsequent rupture. Moreover, hemodynamic stress may also modify endothelial intrinsic signaling. Aoki et al. demonstrated that hemodynamic force activated the pro-inflammatory pathway PGE2-EP2, which then amplified chronic inflammation in an NF-B-dependent manner, resulting in elevated production of various cytokines, including IL-6, TNF-α, and IL-1.[
Psychedelics have anti-inflammatory properties, which may benefit patients with underlying intracranial aneurysms. This opinion may be backed up by the recent of these drugs in different medical illnesses. In addition, as the classical surgery that we know is in decline during the current (21st) century and novel noninvasive therapies are rising, there is a high probability of advancing treatments using medications with major potential, such as psychedelics.
The idea of using psychedelics in treating intracranial aneurysms has parallel examples in the literature. For instance, the application of ketamine in the management of cortical spreading depolarization waves that pathologically occur following specific conditions, including traumatic brain injury, subarachnoid hemorrhage, cluster migraines, and migraine headaches.[
However, the clinical usage of such drugs in treating such patients may face resistance in the scientific communities and the public. Historical, cultural, scientific, and political perspectives are embedded within the story of using psychedelics as a medical therapy. Therefore, advocacy toward minimal invasiveness should be the guiding vector while addressing new potential treatments.
The psychedelics may represent a new addition to the armamentarium for medical doctors treating intracranial aneurysms. However, the pathway toward validation requires significant evidence to confirm their effectiveness and safety.
Patient’s consent not required as there are no patients in this study.
There are no conflicts of interest.
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