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Wednesday, December 11th 2013

Psychofunctional Neurosurgery

The future of functional neurosurgery is going to be really interesting.

This isn’t exactly next day stuff they’re discussing in this NPR story, but it is really fun to see it in the main stream media.

I have major concerns about deep brain stimulation as psychosurgery, not because it might not be effective, but because of the patient population and the systems in place to manage such long term. Few surgeons are going to manage the a patient with depression and the implanted device status post implantation. The devices being studied are largely already in use for other indications; most notably movement disorders such as Parkinson’s disease but the movement disorder neurologists managing such have spent years getting familiar with such. Building a large population of psychiatrists managing such is feasible, especially considering reimbursement associated with managing these, but such is going to take time. It is also going to be very circular, as all new technologies are, in that the more that are implanted the more psychiatrist will manage them but the more psychiatrists managing them the more that are likely to be implanted. As another possibility I’m not sure I’d want one physician managing the device and another the patient’s meds.

Better short term targets for functional neurosurgery might be other “neuro”disorders including dementia which is showing some promise as well in studies. Or how about devices coming online for epilepsy?

Pretty cool stuff.

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