Welcome to the Brave New World of Psychosurgery

ABC News
Posted: Sep 6, 2006

An awake and alert 59-year-old patient with severe tremors is having an electrode implanted deep inside her brain. If successful, this procedure could almost eliminate her debilitating condition.

Dr. Ali Rezai, the lead neurosurgeon at this Cleveland medical facility, turns on the implant's electrical current and, instantaneously, the woman's tremors start to recede.

This remarkable procedure has been used on patients with Parkinson's disease and other movement disorders for more than a decade, and now doctors have started employing it to ease persistent, untreatable cases of depression and obsessive-compulsive disorder.

Welcome to the brave new world of deep-brain stimulation, where surgeons can take a patient from sadness to joy, from fear to serenity, in just a moment. It's a strange ride, but two women had no choice but to climb aboard.

Cindy Warren's Story

Before she received deep-brain stimulation, Cindy Warren of Brighton, Mich., could barely get out of bed. She suffered from severe and incurable depression.

"I wanted to die," she said. "I just hoped something would happen that ... you know, that I could die. I took some alcohol and some over-the-counter drugs."

As with most severely depressed patients, Warren was initially treated with prescription drugs, a dozen or more, she said. But her depression only deepened as the years wore on. She tried shock therapy, too, but the side effects were disastrous.

"Short-term memory loss, and then long-term memory loss," she said.

Kelly Fahrenkrug's Story

A few hundred miles away in Iowa, 37-year-old Kelly Fahrenkrug was living through her own kind of hell with an extreme case of obsessive-compulsive disorder.

"The outside world turned into this big contaminated place," she said. "I had this thing with people contact - didn't know if their hands were washed, didn't know where they had been."

Her husband, Matt, could only watch as she became trapped by her fears."It was like being trapped in a box. I was outside looking in, and she was inside looking out. I could not get her to come outside," he said.

A New Option?

Both Warren and Fahrenkrug chose to undergo five-hour operations during which tiny electrodes were implanted inside their brains. After surgery, psychiatrists got the go-ahead to electrically stimulate the women's mood and anxiety centers, using a handheld device.

In other words, with the touch of a keypad, Fahrenkrug's obsessions and Warren's depression may start to ease, or may not. Deep-brain stimulation is largely an experiment of last resort.

"When you go into the brain, millimeters matter. You go from 1 millimeter and you move 5 millimeters, and it does something totally different to the whole body," said Dr. Donald Mallone. "And so the complexity that's involved in the brain is amazing.

"There's no question: It's still an investigational procedure," he said.

Fahrenkrug is aware of that but said she believed the risk was worth it.

"I didn't want to live the rest of my life the way I was, and I thought there might be a chance, so whatever it took was what I was going to do," she said.

In the Operating Rooms

Brain surgery is always a high-stakes situation. But two skilled doctors, Dr. Kelly Foote at Shands Hospital at the University of Florida and Rezai at the Cleveland Clinic, are skilled in the procedures.

Rezai is Warren's surgeon. He first surgically enters her brain and implants several electrodes that, when turned on later, will activate her emotional centers. The hope is that they will "turn off" her intractable depression. She must be awake during the procedure so that Rezai can monitor her emotions.

The change is startling. During surgery, when low volts of electricity are applied along the contact points, Warren's face lights up. "I was laughing," Warren recalled. "I can remember feeling in surgery, like, 'Wow! You know, if they can make me feel this way ... it might work.'"But when voltage was applied to a slightly different area, Warren cried.

"It was kind of heartbreaking," she said.

Just like Warren, Fahrenkrug's surgery triggers a nearly instantaneous reaction.

"It's like a wave. It's kind of like if you were to put happy gas on, I don't know, but it's a wave that comes over you," she said.

Foote, her surgeon, explained how odd it is to witness.

"I could turn a switch and she would be happy, and I would turn a switch and she would be back down to normal," Foote said.

Emotions Via Remote Control

However, generating emotions in the operating room is not the true test of this medical trial. That comes later, when Warren and Fahrenkrug head to their psychiatrists' offices to have the electrodes turned on in such a way that will, they hope, alleviate some of their symptoms. It means they will need permanent pacemakers to power the signals, too.

Using a handheld device that looks similar to a TV remote, Dr. David Mallone adjusts the voltage on Warren's pacemaker.

"I can actually get to the point where I feel like laughing. I feel kind of giddy, tingly," she said.

Mallone said he's aware of the power he holds in his hands. It's humbling, he said. "And scary."

And, amazingly, it's also a mystery as to why deep-brain stimulation works. But scientists theorize that the electrical currents emanating from the implanted wires scramble the old neural pathways that carried Warren's depressive thoughts and patterns.

"We don't want to make people artificially happy. This is not a cosmetic procedure. Never should it be that we use any kind of brain stimulation to augment a normal [person]," Mallone said. "As I talk to the patients that have gotten this, nobody is happier than they should be. That's really not their goal. They've been burdened with an illness for so long that their goal is to relieve that burden."

Warren agreed. "I want to feel normal," she said.

Suffering Is Alleviated

Back in Florida, Fahrenkrug has also responded extremely well to the procedure, except she needs to have her batteries changed more often than anticipated. When they start to falter, she notices right away, because her symptoms come back

Otherwise, everyone, from her husband to her psychiatrist, is amazed at her progress.

"So when she first started she was virtually housebound. Her life was very restricted and she was very hopeless about her future," said Dr. Wayne Goodman. "Now, although she has some ongoing symptoms ... it's been really life changing for her."

"I can function," Fahrenkrug said, while playing with her daughter. "I can work, I can hang out with friends. My daughter and I go places. So it's pretty close to normal."