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- 1. Preface
- 2. A Prehistory of NMD
- 3. The Story of Phineas Gage
- 4. The Nineteenth Century: Gottleib Burckhardt
- 5. The 20th Century
- 6. Psychosurgery in Europe
- 7. The decline of lobotomy
- 8. A renaissance (of sorts)
- 9. Definitions of Neurosurgery for Mental Disorder
- 10. Psychosurgery under the spotlight
- 11. Conclusions
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Neurosurgery for Mental Disorder - NMD
What is NMD?
NMD is a term used to describe a variety of different procedures. One of the best descriptions is the one given by the Royal College of Psychiatrists (Freeman, 2000):
"A surgical procedure for the destruction of brain tissue for the purposes of alleviating specific mental disorders carried out by a stereotactic or other method capable of making an accurate placement of the lesion"
NMD procedures performed in Dundee include:
At the moment, we do not offer Deep Brain Stimulation (DBS).
Important Facts about NMD
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No-one undergoes NMD in the UK unless they have given informed consent for the procedure. In Scotland, all NMD procedures are overseen by the Mental Welfare Commission for Scotland and all patients who have been referred for NMD are reviewed by the Commission. Every patient also has to be able to give fully informed consent to the procedure.
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NMD is not a common procedure. It is not being done by rogue psychiatrists in every psychiatric hospital. It is reserved for patients who have suffered chronic depression or obsessive-compulsive disorder, that have not responded to all other treatments.
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Only two centres in the UK offer NMD - Ninewells Hospital in Dundee, Scotland, and the University Hospital of Wales, in Cardiff.
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Most modern procedures use an electrical current to generate heat (radiofrequency thermocoagulation) or employ gamma radiation to ablate target areas (the "Gamma Knife"). The exact site for the lesions is calculated using CT or MRI scanning, in combination with stereotactic frames.
References
Freeman, C., Crossley, D. & Eccleston, D. (2000) Neurosurgery for mental disorder. Report from the Neurosurgery Working Group of the Royal College of Psychiatrists. Council Report CR89. London: Royal College of Psychiatrists.
