To Treat OCD, Surgeons Remove Half-a-Teaspoon of Brain
Psychosurgery can help when medication and therapy don't
By Arden Dier,  Newser Staff
Posted Jun 26, 2015 7:23 AM CDT
The highlighted area of this MRI scan shows the anterior cingulate cortex.   (Wikimedia)

(Newser) – Mental illness can be debilitating, leaving sufferers in desperate need of relief. Many don't get it: Medication and therapy have no effect on 30% to 60% of those with obsessive-compulsive disorder, Popular Science reports. "For these patients who are the sickest of the sick they should be allowed the best option at a normal life," says a neurosurgeon. Psychosurgery might be it. Sure, drilling into a person's skull to carve a path for a laser that then melts away half a teaspoon of brain tissue conjures thoughts of the sketchy lobotomies of the 1930s, but science has come a long way since then. Today, scientists know that OCD—the only illness approved for psychosurgery treatment—has been linked to just a few spots in the brain. One of those is the anterior cingulate cortex, the part of the brain that alerts you when a task needs doing, and leaves you satisfied once it's complete, surgeon Sameer Sheth tells Wired.

Those with OCD focus on a particular stimulant and don't get the satisfaction, which is why he or she might wash repeatedly but not feel clean; in "really severe cases," people can be rendered "incapacitated," a psychiatrist adds. If symptoms are especially bad despite therapy and drugs, psychosurgery can be a last resort; only 20% qualify. Using a stereotactic frame—essentially a "giant protractor," per Wired—and CT and MRI scans, surgeons map a route from the skull to the anterior cingulate cortex. "We do a small procedure, see how patients respond, and from that we can learn how to better do the next experiments," Sheth says. And the experiments work: Full relief comes in about 50% of cases, reports Wired, which notes the process might soon be available for those with depression. (Speaking of brains, scientists have figured out how ideas pop into your head.)
 

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