精神科觀察blog

One was a middle-aged man who refused to get into the shower. The other was a teenager who was afraid to get out.
一個是不肯進入淋浴間的中年男子，另外一個是害怕走出淋浴間的青少年。

The man, Leonard, a writer living outside Chicago , found himself completely unable to wash himself or brush his teeth. The teenager, Ross, growing up in a suburb of New York , had become so terrified of germs that he would regularly shower for seven hours. Each received a diagnosis of severe obsessive-compulsive disorder, or O.C.D.
中年男子李奧納德是住在芝加哥市郊區的作家，發現自己完全無法淋浴或刷牙。青少年羅斯在紐約市郊區長大，因為對細菌感到非常害怕而經常連續淋浴7個小時。兩人經診斷都罹患重度強迫症。

They eventually traveled to a hospital in Rhode Island for an experimental brain operation in which four raisin-sized holes were burned deep in their brains.
他們最後前往羅德島州的一家醫院接受一種實驗性的腦部手術。醫師在他們的腦部深處灼出4個葡萄乾大小的孔。

Today, two years after surgery, Ross is 21 and in college. “It saved my life,” he said. “I really believe that.”
2年後的今天，羅斯已經21歲，並在大學就讀。他說：「它救了我的一生。我真的這麼認為。」

The same cannot be said for Leonard, 67, who had surgery in 1995. “There was no change at all,” he said. “I still don’t leave the house.”
67歲的李奧納德1995年接受手術，結果卻不相同。他說：「毫無改變。我還是足不出戶。」

The first real application of advanced brain science is a precise, sophisticated version of an old and controversial approach: psychosurgery, in which doctors operate directly on the brain.
這是先進腦部科學的首次真正運用，施作的是已有多年歷史，且曾引起爭議的治療方法「精神手術」的精準成熟版，精神手術也就是醫師直接對腦部開刀。

This year, for the first time since frontal lobotomy fell into disrepute in the 1950s, the Food and Drug Administration approved one of the surgical techniques for some cases of O.C.D.
美國食品藥物管理局今年核准為某些強迫症病人施以其中一種手術。這是額葉切除術於1950年代引起非議以來的首見。

While no more than a few thousand people are impaired enough to meet the strict criteria for the surgery right now, millions more suffering from an array of severe conditions, from depression to obesity, could seek such operations as the techniques become less experimental.
雖然目前只有幾千人病情嚴重到符合接受手術的嚴格標準，另外卻有數百萬人罹患各種嚴重的疾病，包括憂鬱症與肥胖。隨著相關醫術逐漸脫離實驗階段，他們可以尋求這種手術的協助。

But with that hope comes risk. Given the history of failed technique, like frontal lobotomy, said Dr. Darin D. Dougherty, director of the division of neurotherapeutics at Massachusetts General Hospital and an associate professor of psychiatry at Harvard, “If this effort somehow goes wrong, it’ll shut down this approach for another hundred years.”
然而風險伴隨希望。麻省綜合醫院神經治療科主任兼哈佛大學精神病學副教授杜格迪表示，由於有額葉切除等手術失敗的歷史在前，「如果這種嘗試出了什麼紕漏，這種方法又得停擺100年」。

In one procedure, called a cingulotomy, doctors drill into the skull and thread wires into an area called the anterior cingulate. There they pinpoint and destroy pinches of tissue that lie along a circuit in each hemisphere that connects deeper, emotional centers of the brain to areas of the frontal cortex, where conscious planning is centered.
在執行大腦扣帶迴燒灼術時，醫師會以工具鑽入頭蓋骨，將金屬絲穿入一個名為前扣帶的區域，接著鎖定並銷毀位於大腦左右半球迴路沿線的少量組織。這個迴路連接大腦的情緒中心與職司規畫的額葉皮質區。

This circuit appears to be hyperactive in people with severe O.C.D., and imaging studies suggest that the surgery quiets that activity. In another operation, called a capsulotomy, surgeons go deeper, into an area called the internal capsule, and burn out spots in a circuit also thought to be overactive.
這個迴路在罹患重度強迫症的病人身上似乎過度活躍。造像研究結果顯示，手術可以緩和這種活動。在另一種名為晶狀體囊切開術的手術中，醫師切得更深，進入一個名為內囊的區域，然後燒掉一個可能同樣過度活躍迴路上的斑點。

A different approach is called deep brain stimulation, or D.B.S., in which surgeons sink wires into the brain but leave them in place. A pacemaker-like device sends a current to the electrodes.
另一種不同的手術名為深層腦部刺激術。醫師將電線插入腦中並讓它留在那裡。一個類似心律調整器的裝置可將電流送到電極。

In another technique, doctors place the patient in an M.R.I.-like machine that sends beams of radiation into the skull. The beams pass through the brain without causing damage, except at the point where they converge. There they burn out spots of tissue from O.C.D.-related circuits. This option, called gamma knife surgery, was the one Leonard and Ross settled on.
在另外一種手術中，醫師將病人放在一種類似磁振造影機的機器上。它可將放射線束送進頭蓋骨。除了會合點以外，穿過頭蓋骨的放射線束不會造成傷害。放射線束交會時燒掉與強迫症有關的組織斑點。這種名為伽瑪刀療法的手術就是李奧納德與羅斯當初接受的手術。

Dr. Ben Greenberg, the psychiatrist in charge of the program at Butler Hospital in Providence , Rhode Island , said about 60 percent of patients who underwent either gamma knife surgery or deep brain stimulation showed significant improvement, and the rest showed little or no improvement.
羅德島州普羅維登斯市巴特勒醫院負責這項計畫的精神病醫師葛林柏格表示，接受伽瑪刀手術或深層腦部刺激術的病人，約6成術後病情顯著改善，其他病人則效果甚微或毫無改善。

To quality dor surgery, the disorder must be severe and disabling, and all standard treatments exhausted.
符合動手術的條件是，失調症狀必須非常嚴重，足以使人失能，而且已經試遍各種標準療法。

“We get hundreds of requests a year and do only one or two,” said Mr. Richard Marsland, who oversees the screening process at Butler Hospital . “And some of the people we turn down are in bad shape. Still, we stick to the criteria.”
巴特勒醫院負責篩選病人的馬斯蘭德表示：「我們每年會接到數百件申請，但只核准 一兩 件。我們駁回的人有些情況很糟糕。儘管如此，我們還是嚴守標準。」

原文參照：
http://www.nytimes.com/2009/11/27/health/research/27brain.html 

Interactive Multimedia : Patient Voices: O.C.D.
http://www.nytimes.com/interactive/2009/09/24/health/healthguide/TE_OCD.html

2009-12-22/聯合報/G5版/UNITEDDAILYNEWS 陳世欽 原文請見12月22日紐時周報十版右