The New York Times has an excellent article on how the development of new and more focused brain surgery techniques for the treatment of mental illness are leading to a tight-rope situation where doctors are trying to balance enthusiasm for a potential new treatment while avoiding its inappropriate use and bad publicity.
The use of neurosurgery for treatment of psychiatric disorders has a bad name. It is associated with the frontal lobotomy and leucotomy procedures which were carried out in large numbers in the 1940s, 50s and 60s on the basis on poor evidence and with very little oversight.
The dreadful excesses of this era have thankfully passed, and, with an increased understanding of brain circuity, it has been possible to trial the effect of very focused surgical interventions on certain neurological and psychiatric disorders.
Deep brain stimulation (DBS) is the most popular procedure, which is partly because the implanted brain electrode can be very accurately targeted, and partly because, in principle, the effect is reversible as it relies on electrical current for its effect, although the dangers of brain surgery still remain.
Neurosurgical procedures are also being used to permanently alter the brain by making cuts or lesions to specific areas.
This has been used for many years in Parkinson’s disease to treat tremors (the distinctive ‘shaking’) because the circuits that control movement are quite well understand and easy to study because there are many objective and accurate ways of measuring movements.
Although the numbers are still tiny, the same strategy is being increasingly to treat severe mental illness. Searching PubMed for its common scientific name – ‘functional neurosurgery’ – brings up studies where it has been used on everything from addiction to chronic pain.
And this is where people get nervous, because the procedures are quite experimental still and the researchers are well aware of the dangers of being labelled as ‘modern day lobotomists’ if something goes wrong.
As the article nicely outlines, the challenge is not so much the control of symptoms, which is relatively easy, it’s doing this while avoiding of adverse effects, like cognitive impairments, brain damage or additional mental instability.