Home » Psychosurgery » Psychosurgery Part 2 – Capsulotomy and Anterior Capsulotomy

Psychosurgery Part 2 – Capsulotomy and Anterior Capsulotomy

*Note: This surgery is also used for cataracts and laser eye surgey, except in the eye, not the skull.

This involves drilling holes in the skull. That sounds pretty scary, but it’s actually pretty safe! This surgery was originally performed in Sweden. Small holes are drilled into the skull and electrodes are inserted into the brain, then heated up and small areas of tissue are destroyed. If there is no response, a second surgery is performed. 20% of the surgeries done are being performed again.

Since this surgery was introduced, some neurosurgeons use gamma knives to avoid drilling into the skull.

In the first 116 patients operated on by Leksell, 50% of patients with obsessional neurosis and 48% of depressed patients had a “satisfactory” response. Only 20% of patients with anxietyneurosis and 14% of patients with schizophrenia showed any improvement. In this classification system, only patients who were free of symptoms or markedly improved were judged as having a satisfactory response.

Of the patients who were rated as worse after capsulotomy, nine were schizohphrenic, four were depressives and three obsessives.

Percentages of Success and Failure with Capsulotomy Psychosurgery

Satisfactory Response to Capsultomy

  • Obsessional Neurosis – 48%

  • Anxiety Neurosis – 20%

  • Schizophrenia – 14%

Rated Worse After Capsultomy Psychosurgery – 14%”1

Side effects from this surgery include: emotional blunting, indifference, low initiative, fatigue and urinary incontinence. Studies2 have shown that the procedure is relatively safe.

However, at the 1-year follow-up, 7 patients reported fatigue, 4 reported poor memory, 2 felt more talkative, and 2 reported carelessness. In a recent study 13 of 15 patients had a permanent behavior disorder after postoperative brain edema, but the other 14 did not have any permanent adverse effects, and the study therefore indicates that the procedure is relatively safe.“2

Safety:

Brain surgery sounds dangerous, and it can be! There are risks to any surgery, though, especially when a general anesthetic is used. A case study2 shows that 9 patients attempted suicide before undergoing the procedure and one committed suicide after the surgery. One of the 9 patients developed radiation necrosis (infection), apathy, memory problems and executive dysfunction. This can be caused by using too strong a gamma ray.

It appears to be weight neutral, but can effect libido, a side effect of many medications.

I found an interesting case study on a woman killing herself through anorexia with obsessive-compulsive disorder, here it is:

Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report.

BACKGROUND AND IMPORTANCE:

State-of-the-art treatment of anorexia nervosa (AN) and obsessive-compulsive disorder (OCD) often proves ineffective. Both disorders have common features, and anterior capsulotomy is a last-resort treatment for OCD. We document the effect of bilateral anterior capsulotomy in a patient with comorbid AN and OCD.

CLINICAL PRESENTATION:

A 38-year-old woman with life-threatening, chronic, treatment-refractory AN and OCD underwent anterior capsulotomy. Psychiatric and neuropsychological evaluations at baseline and at follow-up document the severity and progress of the case. Bilateral anterior capsulotomy resulted in normalization of eating pattern and weight and a significant decrease of food-related and overall obsessive-compulsive symptoms. Psychiatric evaluations and exposure to food cues confirmed the clinical improvement that was evident immediately after surgery and sustained at 3-month follow-up.

CONCLUSION:

This case report suggests that bilateral anterior capsulotomy can be a therapeutic option for patients with comorbid AN and OCD. However, a well-controlled study is warranted.3”

 

Controversy

A 58 year old woman underwent the surgery and became mute and robotic (sort of like catatonic) Due to the location of the surgery the frontal lobes can get damaged badly, there can be damage to high mental functions, judging, insight, future planning, social awareness and creativity. It really is a modern day lobotomy, with a different name.

This is something I would never try, the fail rates are too high and the benefit outweighs the risk.

  1. http://www.winmentalhealth.com/psychosurgery_lobotomy_cingulotomy.php

  2. http://archpsyc.jamanetwork.com/article.aspx?articleid=210096

  3. http://www.ncbi.nlm.nih.gov/pubmed/21471837

  4. http://breggin.com/index.php?option=com_content&task=view&id=148

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3 thoughts on “Psychosurgery Part 2 – Capsulotomy and Anterior Capsulotomy

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