What Lies Ahead for Psychiatric Brain Surgery?

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For some patients, removing brain tissue can help treat OCD and other disorders. But ethical concerns remain

Frieda Klotz, Undark

Psychiatric neurosurgery, which was previously referred to as psychosurgery, involves surgical interventions on the brain to modify its functions. This approach has garnered renewed attention, particularly for its potential to aid individuals with treatment-resistant conditions such as obsessive-compulsive disorder (OCD) and other debilitating mental health issues.

One striking case involves an attorney in his late 30s who struggled for 25 years with OCD that made him compulsively check his vehicle for possible accidents involving pedestrians, despite never having harmed anyone. He devoted countless hours—up to 17 per day—to examining his car for signs of accidents, prevented from living his life by the grip of his disorder.

Diagnosed at age 15 following a personal tragedy, this attorney underwent a plethora of therapies, medications, and treatments, all amounting to prohibitive costs without yielding lasting relief. His quest for a solution took a pivotal turn when he learned of a neurosurgical procedure available at two hospitals linked with Brown University that aimed to alleviate his debilitating symptoms.

In a surgical intervention in December 2023, a neurosurgeon created a small opening in his skull to apply heat, effectively burning away specific brain tissue. This procedure aimed to disrupt the neural pathways associated with OCD, and although initially skeptical, the attorney described the outcome as transformative, relieving him from the relentless burden of his obsessive thoughts.

Historically, the field of psychiatric neurosurgery faced significant stigma, especially after the mid-20th century when lobotomies frequently resulted in severe complications for many patients. However, ongoing advancements have led to refined techniques in this area, targeting conditions such as severe OCD and potentially other treatment-resistant mental health disorders like anorexia nervosa. Proponents argue that for select patients struggling after exhausting conventional treatments, brain tissue removal may represent a promising avenue of care.

Data suggest that a considerable number of individuals may benefit from such interventions, with millions in the U.S. grappling with conditions like treatment-resistant depression and OCD, which affects an estimated 1 to 3 percent of the population. However, those seeking surgical solutions often wait years, as many persist with conventional therapies that fail to deliver relief.

Despite the potential benefits, ethical concerns surrounding these surgical options remain prominent. Recent surveys highlight that a significant number of mental health practitioners express apprehension about the safety of such procedures. There are acknowledged risks associated with psychiatric neurosurgery, including temporary loss of energy, memory impairment, and potential complications such as brain bleeds.

Yet, recent technological advancements have empowered surgeons to perform these procedures with unprecedented precision, significantly mitigating risk levels compared to earlier methods. Neurosurgeons are now equipped to conduct surgeries with enhanced imaging techniques, allowing for more targeted interventions. The acceptance of these methods is evolving, presenting new opportunities to address severe mental health disorders effectively.

Nonetheless, the actual number of patients undergoing psychiatric neurosurgeries remains modest. Data from specialized clinics reveal limited procedure frequency, and outlined eligibility criteria necessitate prior treatment failures, often spanning many years of suffering before considering surgical options.

As practitioners dive deeper into the neuroscience of mental health disorders, the benefits of psychiatric neurosurgery, while clear for certain patients, underline the necessity for improved treatments and protocols that ensure safety and efficacy. Some experts advocate for the necessity of clinical registries to systematically analyze surgical outcomes and build a robust evidence base for these interventions.

At present, the stigma attached to psychiatric surgeries, born from a history of misuse and inadequate research, continues to hinder broader application. As neuroethicists and medical professionals advocate for careful regulation and transparent research, it is crucial to strike a balance between innovation in treatment and patient safety.

The attorney, once paralyzed by his fears, represents a hopeful narrative in this field, expressing gratitude for a surgery that he felt saved his life. With an eye towards the future, he remains hopeful that the young son who witnessed his struggles won’t remember his past symptoms. His experience illustrates the transformative potential of psychiatric neurosurgery while underscoring the ongoing debate surrounding ethical implementation and innovation in mental health treatment.

This article was originally published on Undark. Read the original article.

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