Psychosurgeons Are Burning Away OCD With Lasers

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The term lobotomy scares up stark images of straitjackets and psych wards and One Flew Over the Cuckoo’s Nest, which may be why, in a recent article for Wired about the resurgence of psychosurgeries, writer Nick Stockton never uses the word explicitly to refer to a procedure that sounds a lot like a modern form of the practice. For extremely ill patients — those who have not responded to medications or therapy — laser surgery that targets and literally burns away the affected areas of the brain may help relieve their symptoms.

Currently, the procedure is only FDA-approved to treat people with severe obsessive-compulsive disorder, a condition imaging studies have shown to be linked to an area of the brain known as the anterior cingulate cortex. “Functionally, the anterior cingulate is involved in allocating brainpower to certain tasks,” Stockton writes. “That involves alerting you to a task’s urgency and giving you a feeling of satisfaction when the task is complete.” In people with OCD, this function is taken to an extreme, causing the smallest things to feel pressing. 

And this, Stockton explains, is the brain region psychosurgeons target. “We do a small procedure, see how patients respond, and from that we can learn how to better do the next experiments,” Sameer Steth, who does these surgeries at Columbia University Medical Center, told Stockton. Little bit by little bit, surgeons like Steth burn away the troublesome neurons; in the piece, Stockton describes a procedure that removes “about half a teaspoon of gray matter.” 

One problem with this: It’s not clear whether just one area of the brain is really responsible for complex behaviors like those associated with OCD, said Elizabeth Clark-Poner, a postdoctoral scholar in neuroscience at the University of Chicago. As brain imaging technology has improved, she explained, it’s becoming more evident that the practice of assigning one brain region to one behavior (or pattern of behaviors) may be a result of "our human proclivity to try to place things in clean little categories," she said in an email to Science of Us. "This isn’t to say that ablating part of one of these anatomical regions can’t improve the symptoms of a complex disorder like OCD — it absolutely could —  it just means that we have to be very careful, both in planning things like this, and in analyzing the data afterwards." There’s a lot that neuroscientists still don’t know about the role the anterior cingulate cortex plays in OCD, which means "there’s a lot we can’t predict about how removing gray matter here will impact subsequent cognition and behavior," Clark-Poner added.

Most OCD patients do not qualify for the surgery, but of those who have undergone the procedure, about half have seen their brain functioning improve to normal. Early tests are also hinting that psychosurgery-via-laser could be an effective way of treating depression, according to Popular Science, though this has not yet been given the FDA stamp of approval. This will undoubtedly be interesting to watch in the coming years: The procedure sounds (and is) extreme, but the neurosurgeons who practice it argue that the benefits for people with severe psychiatric illnesses are worth it. “For these patients who are the sickest of the sick,” Charles Mikell, a Columbia University Medical Center neurosurgery resident, told Stockton, “they should be allowed the best option at a normal life.”