Neurosurgical Solutions for Mental Health Disorders through Brain Modulation

Someren Bassetti^*
*Correspondence: Someren Bassetti, Department of Neurology, Inselspital University Hospital Bern, Bern, Switzerland, Email:

Introduction

Mental health disorders represent one of the most profound and persistent challenges to global well-being. With millions suffering from conditions such as depression, anxiety, bipolar disorder, Obsessive-Compulsive Disorder (OCD) and schizophrenia, these conditions not only cause immense individual suffering but also place a significant burden on healthcare systems, families and societies. While psychotherapy and pharmacological treatments have evolved considerably in recent decades, they do not always provide relief, particularly for those with severe or treatment-resistant conditions. This has driven the exploration of innovative neurosurgical approaches, which involve the modulation of brain activity to treat mental health disorders. Neurosurgical interventions aim to directly influence the brain’s complex circuitry, which, when disrupted, contributes to the development and perpetuation of mental illness. Brain modulation techniques such as Deep Brain Stimulation (DBS), Transcranial Magnetic Stimulation (TMS) and neurosurgical procedures like anterior cingulotomy and lobotomy represent a growing field in mental health treatment, offering new hope for patients who have not responded to traditional therapies [1].

Description

Historically, the link between mental health disorders and the brain has been a topic of intense research. Early interventions such as lobotomies, which involved severing certain parts of the brain, were among the first forms of neurosurgical treatment aimed at controlling severe psychiatric symptoms. However, these methods were often crude and led to significant cognitive and emotional deficits in patients. As our understanding of brain function advanced, more targeted and refined surgical techniques emerged, shifting from invasive procedures to less traumatic methods of brain modulation. Today, neurosurgical solutions involve advanced technologies designed to precisely modulate brain activity in areas thought to be involved in mental illness. These interventions can be broadly categorized into two types: invasive procedures (e.g., deep brain stimulation, anterior cingulotomy) and non-invasive procedures (e.g., transcranial magnetic stimulation). Let us explore each in detail. Deep Brain Stimulation (DBS) has become one of the most promising neurosurgical interventions for mental health disorders. DBS involves implanting a small device (a neurostimulator) under the skin of the chest, which is connected to thin, flexible wires that are inserted into specific areas of the brain. These areas are typically targeted based on their involvement in regulating mood, behavior and thought processes [2]. DBS has been found to be effective for conditions such as treatmentresistant depression, Obsessive-Compulsive Disorder (OCD) and Parkinson’s disease-related psychiatric symptoms. In the case of depression, DBS is typically considered when patients do not respond to other forms of treatment, including psychotherapy and pharmacological therapy. Clinical studies have shown that DBS can result in significant improvements in mood, emotional regulation and quality of life for patients suffering from severe depression. DBS has also shown promise in treating OCD, especially in cases where traditional therapies fail. In these cases, DBS targets areas of the brain involved in compulsive behaviors, such as the ventral striatum and the anterior limb of the internal capsule. While DBS has demonstrated efficacy in many cases, the outcomes can vary depending on the individual and the targeted brain area. Additionally, DBS requires careful monitoring, as incorrect settings can lead to side effects such as mood swings, cognitive changes and even worsened symptoms. Nonetheless, for patients who have not responded to other treatments, DBS can be life-changing, providing a new avenue of hope [3]. TMS is FDA-approved for the treatment of Major Depressive Disorder (MDD) in patients who have not responded to at least one antidepressant medication. Research has shown that TMS can be an effective alternative, particularly for patients who cannot tolerate or do not benefit from traditional antidepressants. TMS has also been studied for use in anxiety disorders, schizophrenia and post-traumatic stress disorder (PTSD). One of the major advantages of TMS is that it is a non-invasive procedure, meaning it does not require surgery or anesthesia. Sessions typically last 20 to 40 minutes, with patients remaining awake and alert during treatment. The procedure is well-tolerated, with minimal side effects such as headache or scalp discomfort. TMS has been found to be effective in reducing depressive symptoms in many patients, with some experiencing significant improvement after just a few sessions. However, the treatment may require repeated sessions (typically 5 days per week for several weeks) to achieve lasting results. As with any treatment, the effectiveness can vary between individuals and some patients may not respond at all [4]. Anterior cingulotomy and other invasive procedures can offer substantial relief for patients with severe symptoms. However, as with all surgeries, there are risks involved, including cognitive deficits, personality changes and potential worsening of symptoms. The success of these procedures depends on the precise identification of the targeted brain areas and the skill of the neurosurgeon. Although largely abandoned due to its severe and often detrimental side effects, lobotomy represents an important chapter in the history of neurosurgical treatments for mental illness. The lobotomy involved severing connections between the prefrontal cortex and other parts of the brain, a procedure designed to alleviate severe symptoms of psychiatric disorders such as schizophrenia and depression. While the lobotomy was initially hailed as a revolutionary treatment, its long-term effects were often devastating, leading to cognitive impairments, emotional numbness and drastic personality changes. The widespread negative outcomes ultimately led to the abandonment of lobotomies in favor of more refined and targeted approaches, such as DBS and TMS [5].

Conclusion

Neurosurgical solutions for mental health disorders, particularly those involving brain modulation, have come a long way from the controversial practices of early psychiatric surgeries. Today, techniques such as deep brain stimulation, transcranial magnetic stimulation and anterior cingulotomy offer new hope for patients suffering from treatment-resistant conditions, providing options that were once thought to be out of reach. These innovative therapies have revolutionized the field, providing a more precise, personalized approach to treating psychiatric disorders at their root causes. While these neurosurgical interventions show great promise, they are not without challenges. The precision and skill required in targeting specific brain areas, the potential for side effects and the need for ongoing research to optimize outcomes underscore the complexity of these treatments. As technology continues to advance, the future of brain modulation therapies holds tremendous potential, with the possibility of even more refined and effective treatments for mental health disorders on the horizon. Ultimately, neurosurgical solutions offer a beacon of hope for patients who have not found relief from traditional therapies, contributing to the evolving landscape of psychiatric care. As research continues and new techniques emerge, it is likely that brain modulation will play an increasingly central role in addressing the global mental health crisis.

Acknowledgment

None

Conflict of Interest

None

References

1. Mindell, Jodi A., Alex Bartle, Norrashidah Abd Wahab and Youngmin Ahn, et al. "Sleep education in medical school curriculum: A glimpse across countries." Sleep Med 12 (2011): 928-931.

Google Scholar, Crossref, Indexed at

2. Romiszewski, Stephanie, Felix Edward Kelly May, Elizabeth Jane Homan and Ben Norris, et al. "Medical student education in sleep and its disorders is still meagre 20 years on: A crossâ?sectional survey of UK undergraduate medical education." J Sleep Res 29 (2020): e12980.

Google Scholar, Crossref, Indexed at