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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by lukeds on November 8, 2006, at 18:36:22
Do you know anyone that has been operated with psychosurgery?
I am not talking about lobotomy.
I am talking about Subcaudate tractotomy, Anterior Cingulotomy, Limbic leucotomy or Anterior capsulotomy.
http://neurosurgery.mgh.harvard.edu/Functional/psysurg.htm
And how many money would I need for the operation in the Massachusets General Hospital?
Greetings. lukeds.
Posted by notfred on November 9, 2006, at 0:49:07
In reply to Has psychosurgery helped anyone? or know someone?, posted by lukeds on November 8, 2006, at 18:36:22
Posted by med_empowered on November 10, 2006, at 13:34:58
In reply to Re: Has psychosurgery helped anyone? or know someo, posted by notfred on November 9, 2006, at 0:49:07
The article was interesting, but also somewhat inaccurate. In the US, the range of disorders considered "treatable" by lobotomy actually grew over time; the lobotomy was first performed in the 30s, but hit it big in the 40s-50s, during which time some 40,000 Americans were lobotomized. Freeman even had a van, the "lobotomobile" (his term, not mine) that he used to criss-cross the country on "head hunting" trips (again: his terms, not mine).
Psychosurgery "helps" only by damaging the brain, by destroying the very organ that makes us all human. Yes, it is an option, but I think it is one we would all do well to shun. Patients should not be given brain damage as "treatment," and no ethical physician should mutilate his patients' brains in search of a "cure".
Just my 2 cents.
Posted by lukeds on November 10, 2006, at 16:33:18
In reply to Re: Has psychosurgery helped anyone? or know someo, posted by med_empowered on November 10, 2006, at 13:34:58
It is better than SUICIDE. And the psychosurgery is rising in US and Europe.
Operated NEUROCIENCIA of depression Increase the cases of psicocirugía in the best hospital of the world
Neurosurgeons of the General Hospital of Massachusetts are taking a
end a new technique that, to confirm its results, could modify
psychiatric treatment. The cingulotomía is a surgical procedure
by means of which certain cerebral circuits are sectioned.
.
VICTOR CORDOVA
MARGARET H., of 42 years, decided that she had been too much time in hell
like not worrying the last cartridge. After spending 25 years gotten depressed, of
to have proven 22 different medicines, to be entered four times
and of to have received electroshock, to Margaret she did not scare to him to enter
operating room. The last week, a neurosurgeon of the General Massachusetts
Hospital (MGH) - considered as the best medical institution of the world decided
to operate Margaret of its psicopatología.
The patient arrived at the operating theater sedada, although not slept. After
to apply in the head a special helmet to him of esterotaxia, the specialists him
they made a drill in a zone of the skull. By he himself they introduced one
it guides until a zone of the well-known brain like “gyrus cingulatus”.
With the end of the guide placed in the exact place, the only thing that was
to do was to send a unloading electrical so that the cingulotomía was made.
The idea had Thomas Ballantine, neurosurgeon of Boston, in 1962. The power
perhaps to break certain connections in the límbico system would help some types
of patient in whom all the therapeutic attempts had failed. Without
embargo, the critics arisen to the lobotomies practiced during years 50
and 60 in the obsessive patients paralyzed enough the starting of which it seemed
a promising specialty: psicocirugía.
Of esterotaxia the mortality and, the arrival cleaning same almost null
that it causes east type of technique, has given back psicocirugía part of
expectations on which it counted. In fact, in the MGH they are made between 20 and 30
cingulotomías every year.
With almost 900 conducted operations of this type, the neurosurgeons of
hospital stars of the University of Harvard insist in which the mortality of
the esterotáxica cingulotomía is practically null. The effectiveness of
surgery of the depression in the MGH is of 70%, although one more a revision
exhaustive of 33 patients it only could demonstrate significant improvement in 30%
of them.
The experts do not know surely which can be the reasons by which
psicocirugía makes improve the patients, once they are sectioned certain
cerebral circuits. Doctor Ballantine thinks that the procedure not only
he alters encephalic connections, but that modifies the levels of certain
neuroquímicos components.The young case of the suicidal one. - A work published in the British Journal of
Psychiatry, in 1987, made remember to many psychiatrists the paper that could
to have psicocirugía. One was the case of a Canadian young person of 19 years
with a obsessive-compulsive upheaval that did not allow him to live with normality.
Its terror to the contamination was of such caliber that needed to wash itself
hands every five minutes. A morning decided to commit suicide and a bullet went off
of caliber 22 in the head. The projectile crossed the brain through,
but it did not kill to him.
On the contrary, when the suicidal one left the hospital realized which
it had cured. A race has finished and works in its native city. In
any case, psicocirugía has still very bad press. Experts of
Institute of Technology of Massachusetts thinks that the paper of psicocirugía
it is very little defined.
Psychiatrists and psychologists think that still she is soon for burying the paper that
he can have the psycotherapy in the long term. Other neurocientíficos think, without
embargo, that the advances on the knowledge of the brain that will be in
next years will cause that psychiatry modifies in almost 180 degrees his
therapies.El Mundo is the second best seller paper in Spain behind El Pais.
Greetings. lukeds.
Posted by notfred on November 10, 2006, at 20:39:35
In reply to Re: Has psychosurgery helped anyone? or know someo, posted by med_empowered on November 10, 2006, at 13:34:58
>
> Psychosurgery "helps" only by damaging the brain, by destroying the very organ that makes us all human. Yes, it is an option, but I think it is one we would all do well to shun. Patients should not be given brain damage as "treatment," and no ethical physician should mutilate his patients' brains in search of a "cure".
>There are cases of epilepsy that are only helped by Psychosurgery. Damage is relative; esp. when the part of the brain is destroyed which is causing the seizures.
Posted by Declan on November 11, 2006, at 12:06:49
In reply to Re: Has psychosurgery helped anyone? or know someo, posted by notfred on November 10, 2006, at 20:39:35
Still, there's only so much you can take. This would be too much for me.
Posted by yxibow on November 13, 2006, at 16:49:22
In reply to Re: Has psychosurgery helped anyone? or know someo, posted by Declan on November 11, 2006, at 12:06:49
> Still, there's only so much you can take. This would be too much for me.
That's the whole point.
These are heroic surgeries at best that are performed on a few number of people with informed consent that they may have better or worse results and may have any sort of impediment as a result.
If you had an otherwise untreatable seizure disorder as mentioned as an example, and it was absolutely isolated to a section of the anatomy, would you want to continue to have daily multiple potentially very hazardous seizures or take a chance?
These are the sorts of decisions people have to face because we don't have the drug "cures" or palleatives yet for everything out there, especially very difficult cases.
People are not hacking away at brains, at least not in western countries with US standard of care and MRI and PET/SPECT scans showing these sorts of surgeries. Nobody is stealing one's kidneys, etc.
I agree its not a lovely thought and the articles and pictures may make someone cringe, and I am not sure I could take that choice, but if I had the sort of OCD I had years ago and it was instead in the psychotic spectrum and no SSRI, TCA, antipsychotic, etc, was stopping it -- I don't know. I agree I want to keep my gentle spirit and my IQ, some things that may not disappear from surgery, but you never know. So as I say, its a tough decision that few people go through.
-- Jay
Posted by lukeds on November 13, 2006, at 19:08:41
In reply to Re: Has psychosurgery helped anyone? or know someo » Declan, posted by yxibow on November 13, 2006, at 16:49:22
I am totally agree with you. But the psychosurgery is a TABOO cause the abuse of the first psychosurgeons made to a lot of patients, since the Nobel Prize awarded Egas Moniz to many more. And for the people psychosurgery=lobotomy="One Flew Over the Cuckoo's Nest"=BAD, when the truth is that the lobotomy is just one of many types of psychosurgery.
The first procedure
.
The lobotomy prefrontal proposed by Moniz - he made a trepan hole in one area where there are not big glasses and it cut, with a leucotomo, the substance white of the front lobe - it was effective for the treatment of some
alterations of the behavior and the technique you began to extend for all the
countries. With the time, the technique of the front radical lobotomy left
reducing to more restricted leucotomías, although the security of the one
procedure you began to question as they went accumulating data.The operations were made "by hand run off with" with very little control of the size of the
lesion and with a high risk of hemorrhages. Also, this technique was not carried out
with the same seriousness in some places that in others. Most of the times not
they were specialized neurosurgeons those that operated, but neurologists, surgeons
general or even itinerant doctors without any training in the area of
the neurosurgery."In USA, mainly, it was operated without surgical indication any, and it was made
until in traveling régime, as if was a panacea", the doctor Gerardo says Martin, boss of Neurosurgery of the medical center The Operetta of Madrid. Among 1949 and 1952, they were practiced some 5.000 lobotomies a year in USA in these condition. The sick person's selection was only made based on the symptoms. Of way that was not tasted like certain science why it causes it was operating to a patient, and if a patient died I/you/he/she was impossible to know if I/you/he/she had been for the technique in yes or because, for example, there was a cerebral tumor that there was not you
been able to detect.Nevertheless, there were places in those that it was made in a more rigorous way. In Sweden,
for example, the doctor Rylander of Karolinska selected well to those patient and it used a surgical technique very purified with the one that obtained good results and few complications. They were the years 40.
With the time, they were being therapeutic measures - as the shock with
cardiazol, or later the largactil that was the first medication that it controlled some aspects of the mental illness and that it relaxed them a lot-, and the psicocirugía left restricting.However, it continued there being sick
desperate that didn't respond to the treatment that you/they suffered a lot that you
they committed suicide that made homicides, etc.
In Sweden, at the end of the years 50, the doctor's team Leksell - inventor of the one
"gamma knife", a variant of the radiotherapy but for the brain - he/she carried out a
I study very promising. He/she made a group of 60 patients to those that it operated with one
revolutionary technique: the estereotaxia. Instead of having to open up, that that you
he/she made it was to put an electrode of a millimeter and to make clottings in a small one
volume intracraneal located in a critical point.This way, the size of the lesions decreased in an important way - of several centimeters to some few millimeters - and the colateral effects were minimum.
Before, to arrive to a concrete area of the brain with the purpose of "cutting"
determined fibers that cause the symptom supposed, literally, to cross the
area of the previous brain to the lesion. That is to say, to provoke dysfunctions in the rest
of the brain. However, the technical estereotáxica, with a sophisticated system
of coordinated, it allowed to direct the "shot" to the exact place in the one that you
he/she wanted to intervene.In Spain, the first psychosurgeries was made in the year 1966. The doctor
Juan Antonio Burzaco, of the Service of neurosurgery of the Hospital Ruber
International of Madrid that Leksell was working with the doctor in Sweden,
he/she took charge, together with the doctor López Ibor, of the first cases in the one
Clinical Hospital of Barcelona. And, nowadays, with 30 years of experience in
this field and about 360 operated patients, the doctor Burzaco is, practically,
the only person in Spain that carries out interventions of this type."The first patient that I operated was a 21 year-old girl with neurosis that you
it had cut two or three times times the language in spite of the medication and of
to be entered", the doctor counts Burzaco. From then on, those have appeared
modern diagnosis techniques (the resonance, TAC, PET - that takes
installed in Spain one year -, etc), able to depict the operation and the
it structures of the brain of a patient, they have been medications very
effective and they have advanced a lot the studies of the brain.
Faced opinions.However, there are specialists that say that, with scientific rigor, it is
impossible to come closer to a problem of the mind with a scalpel, because still
it is a lot to discover in what refers to the cerebral connections. It is
the case of the doctor Francisco Lives, professor of the Department of Physiology
Human of the Ability of Medicine of the University of Alcalá De Henares of Madrid that
it sustains that there is not any foundation experimental clearing of what you is
making in psicocirugía. It is "as killing flies to gunshots", he/she says the one
neurologist.But, on the other hand, today there is still a number of upset sick persons that you/they have
that to be tied to the bed because they don't respond to any medical treatment and
the colateral effects of the quantity of fármacos that have to take are
worse than to have them fellows. Other, in spite of the medication, they are cases
exasperating that they try to constantly commit suicide and they have stayed
paralytics, or almost, in the intent; or you automutilan, sometimes being provoked the
death; or they are aggressive, violent individuals, or in those that the suffering is
harrowing and constant. They are sick irreversible, chronic, very serious, for
those that the psicocirugía is the last alternative that they have left to prove for
to put an end to the nightmare. However, this specialty continues being the center
of all the critics in the Congresses of Psychiatry. "Only to speak of this
fear, you burn - the doctor Martin says that sporadically also carries out
operations of this type -.But this whole climate goes back to the history that
each one counts to their way, and to the bad practice that was made before the 50."
According to the doctor Burzaco, many specialists rush critical against the
psicocirugía without having never seen a patient or without having revised the
bibliography to analyze the results. It is "as to see the reality and to refuse to
to accept it", he/she says. In a World Congress of Biological Psychiatry taken place in
Stockholm at the beginning of the 80 came out to it floats some hard ones critical during
the course of a round table dedicated to the treatment of the aggressiveness
pathological.I "proposed that comes to Madrid that sees the files of those
people that we have operated, because they are public, and that after seeing them
they could say. Meanwhile, the only thing that is achieved is to convert a meeting
scientific in a political" mítin, Burzaco says. Some psychiatrists allege that
it is a he/she arms of double edge that could be used against the political prisoners,
against the women, against the children. However, according to Burzaco that argument
it is not scientific and you can apply everything, not only to the psicocirugía. "A
knife you can use to give the life or to give the death - he/she says
Burzaco -.And two hours of television they have ended up harming more than a
neurosurgeon in all their life. What happens is that the mysterious thing or that that not
we know it seems always dangerous."
"Nowadays, in the world psicocirugías is making in those that PET
it shows the cerebral operation clearly before and after the operation and
he/she is proven how the patient's situation has been normalized - he/she says the one
specialist -. And one has seen how a girl of 20 or 21 years that it took from
the 14 suffering a neurosis, he/she becomes a free woman and without complex
after the intervention." According to the doctor's data Burzaco, in a valuation
carried out recently with the operated patients of psicocirugía in Spain,
70% of the sick persons had improved in an important way and, with or without
medication, they could make a normal life.
20% improved, although not enough. And 10% to hardships modified.The doctor Enrique Ferrer, boss of the service of neurosurgery of the Clinical Hospital
of Barcelona, he/she doesn't doubt that "this surgical technique will return. Because when
it is very suitable, the psicocirugía offers some very correct results. Without
I levy, now it is a so much discredited, and the psychiatrists don't usually think
in her like a solution for their patients."
On the other hand, all the specialists not omen him/her so good future to this
procedure. The doctor Francisco Lives he believes that "as we advance in the one
knowledge of the brain will go separating the coarse thing, and the coarse thing is the
psicocirugía."For the doctor Martin, although today the indications have lowered a lot, "the
psicocirugía has never died and it has never been stopped to practice." The group of the one
Massachusetts General Hospital, in Boston, he/she has not stopped to make a surgery
of the system límbico called cingulotomía estereotáxica to treat those
patient obsessive compulsive that don't respond to the pharmacology, and others
psychiatric problems.Greetings. lukeds.
This is the end of the thread.
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Dr. Bob is Robert Hsiung, MD,
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