Neurosurgery offers potential new hope for patients with severe OCD.
Obsessive-compulsive disorder (OCD) is a mental health condition that can be highly debilitating. Although many patients achieve some relief with traditional treatments such as cognitive-behavioral therapy and medication, a significant group does not respond favorably to these approaches. For these cases, an unconventional but increasingly considered option is emerging: psychiatric neurosurgery. This branch of medicine, still subject to ethical debate, represents a path of hope for those facing the most persistent symptoms.
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Decades later, António Egas Moniz introduced frontal lobotomy as a treatment for various mental illnesses. Despite criticism and the imprecision of the techniques used at the time, he was awarded the Nobel Prize in 1949. However, the debilitating after-effects suffered by many patients created a strong stigma surrounding these surgical procedures.
Over time, technological advances have allowed for more controlled and targeted interventions. According to Smithsonian Magazine, current surgical methods have improved considerably. Frieda Klotz, a specialist journalist, mentions techniques such as capsulotomy, which consists of creating targeted lesions in specific brain regions to reduce symptoms, and Laser Interstitial Thermal Therapy (LITT), used by the Brown University medical team.
Thanks to these innovations, neurosurgeons can operate with greater precision, minimizing side effects and unwanted damage to other areas of the brain. This represents a significant advance compared to the rudimentary procedures of the past.
Several clinical studies have shown that these surgeries can bring substantial benefits to those suffering from resistant OCD. The cited article reports that between 50% and 60% of patients undergoing capsulotomy showed considerable improvement after one year.
Neurosurgeon Nir Lipsman of the University of Toronto noted that the changes observed in some patients have been "some of the most gratifying and incredible" experiences of his medical career. Although these interventions do not replace other treatments, They are usually accompanied by medication and psychological monitoring.
Martina Mustroph, a member of the Emory School of Medicine surgical team, emphasized that these techniques can be effective and safe when applied responsibly and with dialogue between specialists, patients, and families. Furthermore, a review of cases involving anterior capsulotomy concluded that, despite historical prejudices, this treatment is generally well tolerated and safe.
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Despite their benefits, these procedures are not without risks. Possible adverse effects include loss of motivation, memory impairment, and even intracranial bleeding.
Michael Schulder, past president of the American Society for Stereotactic and Functional Neurosurgery, warns about the irreversible nature of these procedures: "When you burn a hole in the brain, it's like letting a horse out of the stable." This underscores the importance of carefully selecting candidates and considering each case individually.
For its part, Rebecca Park, psychiatrist at Oxford University, has documented severe side effects in certain patients, underscoring the need for rigorous evaluations before proceeding.
One of the main challenges in this field is the scarcity of large-scale clinical trials, which are expensive and difficult to fund. G. Rees Cosgrove, chief of functional neurosurgery at Brigham and Women's Hospital, explained that, Although his team has successfully obtained FDA approval for a randomized study of capsulotomy, they do not yet have the resources to conduct it.
Previous research, such as one conducted at Brown University, found no statistically significant differences between the treated and control groups, reflecting the complexity of measuring outcomes in this type of treatment.
Given this lack of conclusive data, some experts propose creating international databases to document the progress and long-term effects of surgical patients. However, as Sabine Müller, a neuroethicist at Charité University Hospital, points out, many current studies fail to meet the scientific standards required, for example, in drug trials.
In the face of the suffering of those who find no relief with conventional therapies, psychiatric neurosurgery continues to emerge as a promising option, although it is still surrounded by caution. Judy Illes, a neuroethicist at the University of British Columbia, emphasizes the need for innovation guided by regulation and safety, so that this therapeutic approach can offer new hope without putting patients at unnecessary risk.
Despite limitations and debates, current advances in neurosurgery represent transformative potential for mental health. With an ethical and evidence-based approach, this discipline could redefine the treatment of OCD and other severe psychiatric disorders in the coming years.
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