In a previous post I mentioned that psychosurgery had returned to England after an absence of more than a decade (although a few operations have been done during this period in Wales and Scotland). The Care Quality Commission (CQC) in their first annual Mental Health Act report referred to an operation performed at Frenchay Hospital, Bristol, last February. Psychosurgery, also called neurosurgery for mental disorder (NMD), is a form of neurosurgery in which a bit of the brain is destroyed in the hope of alleviating the symptoms of mental illness. It is covered by section 57 of the Mental Health Act and can only be carried out with the approval of the CQC. The doctors who performed the operation in Bristol have been publicizing it this week, with TV coverage and a number of newspaper articles. Here for example is an item on the BBC, an article in the Daily Mail and one in the Daily Telegraph.
Although the headlines (“deep brain stimulation hope for depression” from the BBC, “Grandmother who battled depression for 10 years recovers after having brain implant” from the Daily Mail) give the impression that this is a success story for deep brain stimulation (DBS – a form of treatment in which electrodes are implanted in the brain and which, unlike ECT and psychosurgery, is not covered by the Mental Health Act), it is actually about someone who failed to benefit from both DBS and ECT, except in the short term, which is why she went on to have what the CQC call “the older ablative procedure“. The particular form of psychosurgery used was an anterior cingulotomy, an operation in which part of the anterior cingulate gyrus is destroyed. It was first used in the UK in 1948. But Bristol Neuroscience are presenting it as something new and exciting, and the media have accepted it as such uncritically. One website got carried away with adjectives and talked about radical new pioneering surgery for depression…being pioneered for the first time.
The only thing that appears to be new is that the surgeon used “guide tubes” while operating. I am not sure exactly what guide tubes are, but presumably they are pieces of equipment which make the operation easier or more accurate. With any neurosurgical operation, however, you would expect some of the equipment to have changed a bit since 1948. I was disappointed that the NHS Behind the headlines website (“We give you the facts without the fiction”) did not select this as one of their featured health stories this week.
The doctors who performed the surgery are based at the Burden Centre at Frenchay Hospital, Bristol. The Burden Centre was featured in a previous post.