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For which disorder does this non-ECT stimulation or neurosurgery have NICE or evidence support?
More, if you want it
Which illness has stayed severe for the patient after drugs and therapy?Tap a term: its definition, what you can do with it, and how often the exam asks it.
Definition: an operation that makes a permanent brain lesion to treat severe treatment-resistant OCD.
You can: Tell anterior cingulotomy from deep brain stimulation by whether the operation makes a permanent lesion.
Definition: electrical stimulation of a brain region through an implanted pacemaker-type stimulator.
You can: Tell deep brain stimulation from rTMS by whether a stimulator is implanted under the skin.
Definition: magnetic stimulation of the brain from a coil outside the head, supported by NICE for depression.
You can: Tell rTMS from deep brain stimulation by the disorder that NICE or the evidence supports.
Each card is one term. The grey line is what the patient says, which is what the question stem gives.
Summary
Anterior cingulotomy is a neurosurgical operation that makes a permanent lesion in the brain to treat severe OCD.
is a neurosurgical operation that makes a permanent in the brain to treat severe OCD. NICE allows only in severe, OCD. NICE does not allow neurosurgery in anorexia nervosa, tic disorder, ADHD or autism. Anterior cingulotomy is one of the surgical options used in severe treatment-resistant OCD.
Neurosurgery is for chronic, disabling OCD that has failed other treatments first. Cutting brain tracts helped a proportion of highly treatment-refractory patients. Surgery is not indicated when the illness comes from organic brain disease or a pervasive developmental disorder. Autism is excluded for that reason.
Anjali is a 34-year-old pharmacist seen at a national OCD service in London. Anjali has had many years of drugs and therapy without improvement. Anjali says, "I want to know which operation has real support."
Candidates pick neurosurgery for severe anorexia nervosa, tic disorder or ADHD. NICE allows neurosurgery for mental disorder in severe treatment-resistant OCD alone. A stem with any other disorder rules neurosurgery out.
Capsulotomy is another ablative operation used in treatment-refractory OCD. ECT does not seem useful in OCD, so ECT is no alternative to surgery.
Mnemonic
Cut first, switch next, magnet for mood. Cue: severe, treatment-resistant OCD
Cut is anterior cingulotomy, a permanent lesion with the best evidence in severe OCD. Switch is the implanted stimulator of deep brain stimulation, the next choice in OCD. Magnet is the rTMS coil outside the head, which NICE supports for depression.
4 more sections on Neurosurgery and brain stimulation for mental disorder: anterior cingulotomy, deep brain stimulation and rTMS
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