Posted by greywolf on September 11, 2012, at 23:51:20
In reply to Re: Bipolar/OCD long-term med issues, posted by jono_in_adelaide on September 11, 2012, at 23:11:21
> I know the mere mention of psychosurgery brings up images of "One flew over the cuckoos nest" and such like, but it has changed a lot since then, and if you have tried every possible alternative, it might be worth considering - I know I would atleast closely look at if if i hadnt found a cocktail of drugs to keep my anxiety, panic attacks and depression at bay.
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> I'd first look at deep brain stimulation, then at what if anything psychsurgery might have to offer, preferable at a center like Menninger
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> From the Wikipedia article on Psychosurgery
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> Psychosurgery today:
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> All the forms of psychosurgery in use today (or used in recent years) target the limbic system, which involves structures such as the amygdala, hippocampus, certain thalamic and hypothalamic nuclei, prefrontal and orbitofrontal cortex, and cingulate gyrus all connected by fibre pathways and thought to play a part in the regulation of emotion.[19] There is no international consensus on the best target site.[19]
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> Anterior cingulotomy was first used by Hugh Cairns in the UK, and developed in the US by H.T. Ballantine jnr.[12] In recent decades it has been the most commonly used psychosurgical procedure in the US.[19] The target site is the anterior cingulate cortex; the operation disconnects the thalamic and posterior frontal regions and damages the anterior cingulate region.[19]
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> Anterior capsulotomy was developed in Sweden, where it became the most frequently used procedure. It is also used in Scotland. The aim of the operation is to disconnect the orbitofrontal cortex and thalamic nuclei.[19]
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> Subcaudate tractotomy was the most commonly used form of psychosurgery in the UK from the 1960s to the 1990s. It targets the lower medial quadrant of the frontal lobes, severing connections between the limbic system and supra-orbital part of the frontal lobe.[19]
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> Limbic leucotomy is a combination of subcaudate tractotomy and anterior cingulotomy. It was used at Atkinson Morley Hospital London in the 1990s[19] and also at Massachusetts General Hospital.[20]
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> Amygdalotomy, which targets the amygdala, was developed as a treatment for aggression by Hideki Narabayashi in 1961 and is still used occasionally, for example at the Medical College of Georgia.[21]
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> There is debate about whether or not deep brain stimulation (DBS) should be classed as a form of psychosurgery.[22]
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> Endoscopic sympathetic block (a form of endoscopic thoracic sympathectomy) for patients with anxiety disorder is sometimes considered to be a psychiatric treatment, despite it not being surgery of the brain. There is also renewed interest in using it to treat schizophrenia.[23] ESB disrupts brain regulation of many organs normally affected by emotion, such as the heart and blood vessels. A large study demonstrated significant reduction in "alertness" and "fear" in patients with social phobia as well as improvement in their quality of life.[24]
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While I am not afraid of surgery and, indeed, have had surgery to implant the experimental VNS stimulator as part of a trial, DBS is very much a last resort. Admittedly, it looks like I am at last resort time, but DBS is pretty scary to me.
poster:greywolf
thread:1025444
URL: http://www.dr-bob.org/babble/20120830/msgs/1025475.html