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
To Treat OCD, Surgeons Remove Half-a-Teaspoon of Brain
The highlighted area of this MRI scan shows the anterior cingulate cortex.   (Wikimedia)

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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