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Dr. Bob is Robert Hsiung, MD,
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Posted by jrbecker on August 7, 2003, at 22:19:23
http://manisses.com/2online/PUAlert/PA.html#clinical%20Updates
Manisses Psychopharmacology Alert
August 7th, 2003
Editor's NoteIs psychosurgery back in vogue? The plight of 1950s and 60s lobotomy patients is most likely imprinted on all our psyches, having seen movies such as "One Flew Over The Cuckoo’s Nest" and "Francis." However, a recent Los Angeles Times article highlights the growing field of what experts now prefer to call "neurosurgery for severe psychiatric illness" and looks at a more precise kind of brain surgery — including capsulotomy, cingulotomy and deep brain stimulation — and what some doctors are calling a new ray of hope for patients with disorders such as OCD and depression who do not respond to other treatment.
Frontal lobotomy, invented by in 1935 by Dr. Egas Moniz who received a Nobel Prize in medicine for his efforts, involved cutting into the frontal lobe (an area of the brain involved with impulse control and mood regulation) in the hopes of lessening violent, agonizing thoughts and behaviors. This operation was performed on more than 50,000 Americans with some very mixed results as we know.
Since then, according to the LA Times piece, neurosurgeons stress that they have a much better understanding of how the brain functions and can perform much more precise kinds of surgery. During a capsulotomy, probes are inserted through the top of the skull near the thalamus and connecting to the cortex, whereas a cingulotomy sends probes into the cingulum, an area of the brain that appears to regulate the circuit that is hyperactive in OCD patients, and burns away tissue. Deep brain stimulation is less invasive because no tissue is destroyed, rather wires connected to the capsule send a high frequency current to interrupt the circuitry connected with OCD.
Results from this kind of surgery have been encouraging, according to researchers, though success rates range between the 35-45% mark and there has been at least one case of severe brain damage caused by a combined capsulotomy/cingulotomy surgery. The federal government has funded two OCD brain-surgery studies this year and further research will hopefully allow experts to more fully understand how the operations affect the brain and why.
To read the full story in the LA Times, click here.
http://www.latimes.com/la-he-psychsurgery4aug04,0,1778577.story
Before I sign off, I also wanted to thank those of you who sent in suggestions for our special focus issues that we will be bringing you every 4th issue of Psychopharmacology Alert. Suggestions so far include the issue of whether newer atypical antipsychotics cause diabetes and another reader wants to look at the problem of treatment noncompliance. Keep your ideas coming so that we can provide you with the information that you most need.
Karienne Stovell
Senior Managing Editor
kstovell@manisses.com
Posted by jay on August 7, 2003, at 23:15:03
In reply to Newer neurosurgery looks to avoid lobotomy stigma, posted by jrbecker on August 7, 2003, at 22:19:23
One thing I am very suspicious and wonder about this is that there really can't be any "controlled scientific" studies. Hence, you could very easily get a placebo-type effect, and there are no controls to compare to. I'd also question the possibility of brain damage, because it could also be that a life with brain damage is even far more distressing than a suicide. (I am not trivializing suicide or depression...of course they are absolutely horrible. But, let's compare that to a life where you are pretty much just barely 'surviving' in a vegetable-like manner because of brain damage. What kind of 'life' is that?) So, given both arguments above, I don't think it is a risk anyone should ever take. I've lived with depression for about 20 years, about 12-13 medicated, and nothing would scare me more, and likely turn me to suicide, than having brain surgery. I'd rather be on 15 different medications, living on disability (which is *nothing* to be shameful about) than have my brain organically destroyed.
This may be an extreme opinion...but I am just being honest.
Thanks...and best..
Jay
This is the end of the thread.
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