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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What alternatives are there?

There are two surgical alternatives to NMD, neither of which involves permanent damage to brain tissue (this means they can be reversed). These are:

Deep brain stimulation (DBS)

What is it?

DBS involves a procedure similar to the NMD operation. A stereotactic frame is used to implant electrodes (insulated wires that conduct electricity) in your brain, but, instead of destroying the cells, the electrodes are left in place and used to stimulate a small area of your brain. Wires lead just under your skin from your brain to a stimulator (similar to a pacemaker), which is set in your chest wall, and is programmed to deliver high frequency electrical stimulation. It uses a special battery to work, which is sometimes rechargeable.

This technique is likely to improve, and DBS may eventually replace NMD.

The Care Quality Commission has expressed concern that DBS is currently unregulated in England and Wales, and could therefore theoretically be given to someone who has not given consent or who lacks capacity. This is not the case in Scotland, where DBS is covered by the same rules as NMD.

What is it used for?

Studies on DBS have involved only small numbers of people, but this research suggests it can treat:

  • most cases of severe depression
  • long-term OCD that has not been helped by other treatment
  • movement disorders such as Parkinson's disease

With both depression and OCD you might find DBS very helpful while the stimulation is turned on, but your problems could return when it is turned off. The National Institute for Health and Care Excellence (NICE) has produced clinical guidelines for the use of DBS in Parkinson's disease, but not for depression or OCD.

DBS has sometimes been used in China to treat anorexia (an eating problem), but it is not performed as a treatment for eating problems in the UK.

What are the side effects?

Possible adverse effects from DBS include:
  • infection after the operation
  • complications if the equipment goes wrong

Also, having the DBS implants means that you cannot be treated with electroconvulsive therapy (ECT).

Where is it performed?

DBS is performed in Southmead Hospital, Bristol, as well as the NMD centres in Cardiff and Dundee.

Vagus nerve stimulation (VNS)

What is it?

VNS is a surgical treatment in which a device similar to a pacemaker is implanted in your chest wall, with electrodes connected to the vagus nerve in your neck area. The device sends timed pulses to your vagus nerve, which has branches from many organs of your body to your brain.

What is it used for?

VNS can be used to treat:

  • severe, treatment-resistant depression
  • epilepsy (a neurological disorder that can cause seizures)

No one knows exactly why targeting the vagus nerve can relieve depression or epilepsy, but research shows that up to half of people who have tried it found it helpful. However, NICE has issued this guidance saying that there is not much evidence about how well it works for treating depression, or how safe it is.

What are the side effects?

Possible adverse effects of VNS include:

  • coughing
  • shortness of breath
  • changes in your voice
  • changes to your heart rhythm
  • hypomania or mania
  • your depression could get worse

Where is it performed?

VNS is more widely available than DBS, but it is still only offered in experienced, specialist centres. As it's used most commonly to treat epilepsy, VNS may be more likely to be performed in centres where there is a specialist epilepsy clinic.

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

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