Neurosurgery for mental disorder (NMD)

Explains what NMD is, what the operation is like, possible side effects and alternative surgical treatments. Also covers the law around consent to treatment by NMD.

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Who could be offered NMD?

NMD is extremely rare. It would not ever be considered unless you are very severely ill and all other treatments have failed, including psychiatric medication and electroconvulsive therapy (ECT).

If you are in this situation, your psychiatrist could offer to refer you to a psychosurgical team for an assessment. The psychosurgical team is made up of everyone who would be helping to look after you, including the anaesthetist and the neurosurgeon. Good practice guidelines state that:

  • The psychosurgical team should review your full hospital notes during the assessment.
  • A close relative should accompany you to the assessment, and they should be interviewed as well.

Where is NMD performed?

Assessments can be done at the Maudsley Hospital in London, but there are only two hospitals in the UK where the operation can be performed. These are:

  • (Wales) University Hospital of Wales, Cardiff – this hospital uses the bilateral anterior capsulotomy technique.
  • (Scotland) Ninewells Hospital, Dundee – this hospital uses bilateral anterior cingulotomy for treatment-resistant depression, and either capsulotomy or cingulotomy for treatment-resistant OCD.

There are no NMD treatment centres in England, so if you live in England you would have to travel to Wales or Scotland for the operation. It's important to be aware that the law on consent to treatment with NMD is different in Scotland to Wales.

This information was published in May 2015. We will revise it in 2018.

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