Neurosurgery for Mental Disorder (NMD) is the modern name for psychosurgery. NMD is a very controversial medical field that has not yet undoubtedly proven its merits. The whole medical process is a collaboration between psychiatrists and neurosurgeons in which the goal is to remove or destroy a small piece of the brain to mitigate severe depression or acute obsessive-compulsive disorder (OCD).
Important Facts about NMD
NMD is a very high risk procedure and recommended only if all therapies, including psychiatric drugs and electroconvulsive therapy (ECT), have been totally unsuccessful. Because of the high risk of adverse effects, a few doctors usually recommend this treatment as a very last resort. Patients with this recommendation need to give their consent before NMD can be performed on them.
Other key factors to be knowledgeable of before considering NMD:
- NMD is not a cure. The surgery is done just to decrease the symptoms of the acute mood disorder or OCD but the patient still has to go through psychotherapy and other psychiatric treatments.
- NMD cannot be reversed. The surgery is permanent and therefore whatever side effects there may be can become permanent as well.
- NMD is an extremely rare surgical procedure. Only 4 people in the U.K. received this treatment in the years 2013-2014.
- There are two alternative treatments to NMD: deep brain stimulation (DBS) and vagus nerve stimulation (VNS). While NMD involves taking out a small part of the brain, DBS stimulates parts of the brain with implanted electrodes. DBS has proven to work with severe depression and OCD however in some cases, symptoms come back when the stimuli is removed. VNS involves surgery where a device is planted into your chest. The device’s electrodes are connected to the vagus nerve located at the neck where it sends timed pulses through the nervous system.
- NMD is not done to change or modify a person’s behaviour. If there are any changes, these are usually side effects, not a procedural aim.
- In the U.K., NMD is not recommended for anorexia, personality disorders, and schizophrenia.
- NMD is not a lobotomy, a type of neurosurgery done in the past to treat schizophrenia. Lobotomy had been a controversial procedure and is not, or perhaps very rarely, done today. Although a small percentage benefited from the procedure, most patients were left mentally dull, vacant, and incapacitated.
The NMD Procedure
The purpose of NMD is to break the connections between the nerves in small parts of the limbic system which is thought to be creating the mental issues. The frontal lobes of the brain hold the limbic system which is responsible for emotional responses and some involuntary physical responses such as blood pressure regulation and heart rate changes.
The operation involves drilling a small hole through your skull to allow a fine probe controlled by special imaging software to be guided to a specific area of the frontal lobe. Once in the right spot, an electrical current is pulsed through the probe to destroy a miniscule area of brain tissue. After this, the probe is then removed and the skull cuts are either stitched or glued.
Effects to Mental Capacity and Personality
Since cases are very few, there is no conclusive evidence of the effectiveness or ineffectiveness of NMD. To glean data from just the few, these are the findings of its post operative effects.
No evidence has surfaced to claim that NMD causes any loss in mental or thinking ability. In fact, the operation itself may have dampened or relieved patients of symptoms so that it allows them now to think more clearly and have better concentration.
There are, however, very few patients that have undergone personality changes from the operation.
Side Effects of NMD
NMD can cause:
- Apathy or disinterest. Some patients who went through surgery for severe depression were reported to be indifferent to their issues which used to upset them before the operation.
- Weight gain
- Headaches which can be severe and last for several days
High Risks of NMD
Because NMD touches the brain, it carries high risks common to most brain surgeries:
- Epileptic seizures
- Damage to blood vessels which may cause stroke
- Feeling of pressure in the frontal area. This pressure is caused by fluid build-up by the brain tissues as part of the healing process. Confusion may also result from this fluid build-up and the condition can last for a month after surgery.
The Law on Patient Consent to NMD
The law on patient consent differ between the England-Wales territory and Scotland. The Mental Health Act allows NMD for patients in England and Wales if all conditions are true:
- The patient consents to NMD treatment.
- A Second Opinion Appointed Doctor (SOAD) and two other appointees by the Care Quality Commission in England or the Healthcare Inspectorate Wales certify that (1) the SOAD approves of the treatment; (2) the patient has the capacity to consent; (3) the patient does consent.
It is very important to note that in England and Wales, patient consent is an absolute requirement for treatment, even if the patient does not have the capacity to give his consent. In other words, if the patient lacks the capacity to consent, he cannot receive NMD treatment within England and Wales.
Scotland, however, has a different ruling. NMD can be applied if all conditions are true:
- An appointed medical practitioner by the Mental Welfare Commission has given his approval of NMD’s benefits for the patient.
- A further two lay appointees by the Commission certifies whether the patient has the capacity of giving his consent or not.
- If the patient is capable of consenting, then he is asked for his formal consent. If the patient is incapable of consenting, he should not be objecting to the treatment.
Under Scottish law, as long as the patient does not object to the surgery, the patient can be given the NMD treatment even if he lacks the capacity to give his permission or consent.