The patients suffered from severe depression and many had been in hospital for years. But after the controversial operation, called neurosurgery for mental disorder (NMD), eight of the 14 patients treated could leave hospital and live on their own. Details of the patients dramatic improvement come as British psychiatrists have called for a moratorium on the treatment.
Professor Keith Matthews, a consultant psychiatrist and director of the Dundee Neurosurgery for Mental Disorder Programme at Ninewells, said: Some of these people had not left hospital for between three and seven years. Often they were in intensive care and needed nurses with them all the time. They are now living independently. Even better, they are out and about and some of them are picking up their careers. Some people do extremely well.
Matthews added that while it is important to recognise that neurosurgery for mental disorder does not help everyone, it has transformed the lives of some severely depressed patients.
Clearly, this surgery isnt fabulous for everyone but it does help some people. If you have people moving from being chronically depressed, hospitalised and needing 24-hour nursing to independent living then that is really dramatic. Given how much neurosurgery for mental disorder has helped these people, I do not think it should be allowed to die out.
Neurosurgery for mental disorder involves using a laser to destroy a tiny part of the brain. The irreversible procedure is carried out on patients suffering from severe depression or obsessive compulsive disorders . It is similar to lobotomy operations performed in the 1940s and 1950s which involved severing the frontal lobes of the brain .
Matthews and Sam Eljamel, consultant neurosurgeon at Ninewells, publish the first information on the outcome of patients treated at the Dundee NMD unit in a biennial report to the Scottish Executive. Since 1990, neurosurgery for mental disorder has been carried out on 37 patients at the Scottish unit. NMD is only performed at two units in the UK, one in Dundee and one in Cardiff. Patients travel to the Dundee centre from England and Ireland as well as from around Scotland.
The study includes 14 patients whom doctors were able to assess 12 months after the operation. Eight managed to leave long-term hospitalisation and live independently . One of the eight did relapse and was awaiting further neuro surgery. Of the other six, three experienced no change and one reported no improvement but was living independently. One patient is still depressed but now responds to electroconvulsive therapy (ECT) and another is able to ignore obsessional thoughts.
The report said: Despite collecting data systematically on potential adverse effects we remain struck by the relative lack of evidence for these.
However, the Scottish Association of Mental Health (SAMH) points out that the long-term risks of neurosurgery are still not known.
Richard Norris, SAMH director of policy, said: What this report indicates is that some people have made a recovery by having neurosurgery for mental disorder. Clearly, it doesnt work for everyone. What needs to be looked at is the longer-term side effects. This does need to be thoroughly researched.
Critics claim patients lose other emotions after neurosurgery. In the September issue of the British Journal of Psychiatry, Dr Raj Persaud, consultant psychiatrist at the Maudsley Hospital in London, calls for an end to the procedure. He writes: There are several reasons why our profession should place a moratorium on neurosurgery for psychological problems until further notice.
First there has never been a prospective, randomised double-blind placebo- controlled trial of any psychosurgical procedure, and none is likely .
He adds: Perhaps most importantly, psychosurgery is based on a flawed and impoverished vision of the relationship between brain tissue and psychological disorder. It is unlikely that any psychiatric problem can be located in one so-called abnormal brain region .
12 October 2003