DavidBransfordMD Blog – opinion re: PsychoSurgery

In the current NYTs an update re psychiatric neuorsurgery has been published – http://www.nytimes.com/2009/11/27/health/research/27brain.html?ref=health I support very strongly the critique posted in the Beyond Meds Blog. Vera Sharav gave a powerful and insightful critique to the NYTs article. http://bipolarblast.wordpress.com/
In my own clinical experience, beginning full time psychiatric practice in 1977, I have seen lobotomy patients for follow up that were typically given in the 1950s & 60s. I can not recall any that were helped, many with residual seizures, and most often a total loss of spontaneity, severe memory deficits,etc. The intro of chlorpromazine and all the other potent antipsychotics were perhaps an improvement only because the effects were reversible when tapered off (not considering TD – nor Diabetes with the Atypicals)
A company called Cyberonics received approval from the FDA perhaps 10-15 yrs ago to implant Vagal Nerve Stimulators for Seizure Patients who were not responding well to their anti-seizure meds. http://en.wikipedia.org/wiki/Vagus_nerve_stimulation The stimulator was implanted behind the collar bone and intensity and frequency was adjusted by a neurologist. I have had a number of patients with VNS implants, but have seem little change in their Seizure frequency. There were reports from these patients that some ‘felt better’ – even with the same number of seizures. So the manufacturer attempted to receive FDA approval for treating refractory depression. Thus far, I belief the FDA may have approved it for the depression indication. I have yet to hear from a VNS patient that their mood has improved. Some of the deep brain implants are much more invasive.
If you have not had a chance to read The Lobotomist by Jack El-Hai, I would strongly recommend it. He does an excellent job of documenting the many years of the NeuroPsychiatrist Walter J Freeman MD who was said to have been the major proponent for the Frontal Lobotomy from the 1940s-1970. I have a podcast of an interview with one of his former patients who was interviewed at length on NPR abt 2 year ago. He received outpatient Trans-Orbital lobotomies from Dr Freeman at the age of 12 for what I think today would be diagnosed as Oppositional Defiant Disorder. Jack EL-Hai’s book should be required reading for anyone in the mental health field..It is excellent and he is on Twitter. I just read his incredible book – Minnesota Lost.
Suffice it to say, I believe the NYTs article clearly gives the impression that thru new technology, a much improved method has been developed. Perhaps Morbidity and Mortality has been reduced, but the new technologies still require much more investigative work…I fear, like BigPharma, the Medical Device Companies are the major driving force . dlb