Modern Psychosurgery Part 1: Cingulotomy

That one word scares the shit out of us. Short for “psychiatric neurosurgery”. What do we think of? The icepick lobotomy, Dr. Walter Freeman, “One Flew Over the Cuckoo’s Nest”. But surgeries like this are still being performed, safely and humanely. They are generally last-last resort treatments (with ECT, electroconvulsive therapy, being a last resort treatment quite often) and aren’t offered now as much as they were in the past. It’s not easy to get a lobotomy anymore,they aren’t even called that. Between 1932 and 1954 (when the drug Thorazine became available), there were around 50,000 psychosurgeries performed. Now, there are 200-300 recorded a year1 in the USA (mostly, some are done abroad).

cin·gu·lot·o·my

Electrolytic destruction of the cortex and white matter of the cingulate2

Image

Howard Dully, author of “My Lobotomy”

“Only patients with severe, chronic, disabling and treatment refractory psychiatric illness should be considered for surgical intervention.”3

A cingulotomy is like a modern day, less destructive, version of the frontal lobotomy we’ve heard so much about. Basically, rather than severing or poking the frontal lobes themselves, a bundle of nerves connecting them are “interrupted4”. It is used now to treat obsessive compulsive disorder, some anxiety disorders and mood disorders, and rarely, psychosis4.

The patient, as for all psychosurgeries, must have tried all other therapies (medication, CBT, DBT, maybe ECT or TMS, regular talk therapy and so on and such forth) before being considered for a psychosurgery.

The frontal lobes control reason, impulse control and judgement. This is targeted, along with the “cingulate gyrus”, a small part of the limbic system involved with many emotions6. The functions of the cingulate gyrus are coordinating sensory input with emotions, emotional response to pain and regulating aggressive behaviour.

An electrode or gamma (laser; radiation) knife is used to perform the operation and a small lesion (about half an inch) is created. Patients notice immediate affect on anxiety, but it may take time (6 to 12 weeks) for depression or obsessive-compulsive disorder to lessen. It is still being investigated in the treatment of bipolar disorder.

If there is no response to the surgery, it may be repeated 6 months later. There is a 62% improvement rate. There are con’s, though, to this operation. Short term can be nausea, vomiting and headache. Reaction to anesthesia. The patient is generally functioning well after four days and kept in the hospital for 48 hours. However, there can be permanent unwanted side effects. Those with a history of seizures can risk having more seizures, and those who haven’t had a seizure before risk having one, in the first two months. Memory loss can also occur. It is the decision of the doctor and patient to decide if the benefits outweigh the risks.

Though this surgery isn’t specified for bipolar disorder, it is interesting that the modern day lobotomy is for obsessive-compulsive disorder, rather than what it was previously used for (any mental illness, from depression to schizophrenia, even homosexuality, which was removed from the DSM after III) It has far less risks and is a less invasive procedure, but I don’t think I’d want to go through brain surgery on a 62% improvement rate.

  1. http://www.psychologytoday.com/articles/199203/psychosurgery

  2. http://medical-dictionary.thefreedictionary.com/cingulotomy

  3. Neurosurgical department of Massachusetts General Hospital/Harvard Medical School

  4. http://neurosurgery.mgh.harvard.edu/Functional/cingulot.htm

  5. http://bipolar.about.com/od/treatment/a/bilcingulotomy.htm

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