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HomeAnswersNeurologysleep disorderWill the removal of the amygdala help with better stress response?

Would removing the amygdala treat a person's troublesome stress response and sleeplessness?

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Hitesh Kumar

Medically reviewed by

iCliniq medical review team

Published At January 9, 2023
Reviewed AtDecember 14, 2023

Patient's Query

Hi doctor,

I have a unique problem. For approximately eight years now, I have not slept at all. It is a source of great distress for me. It is due to a man I used to walk around a park with for exercise telling me that I could not calm my mind. My mind and brain are processing what he said as a 'threat,' causing me to have a constant stress response. I have not slept twenty-four hours and every second of the day in the intervening years. It is a full-blown flight or fight response. I cannot take anything to ease it, and it would have to be extremely strong to keep me awake all this time. I concluded that I would have to live my life with this distress bordering on torture, but then I saw on the internet that there was this woman who had a type of disease that destroyed both her amygdalas, and she did not experience any fear or flight or fight response. I also researched removing the amygdala, a fairly common procedure for persons with treatment-resistant epilepsy. In their case, however, they usually remove one of the amygdalas, not both, but because of this patient, it is known that someone can live without both amygdalas. There have been a few other patients with extensive damage to both, and they function, with some effects such as a complete loss of fear, and they might be prone to do dangerous things as a result. This is something that I am willing to compromise on because my illness is more of a burden to me than that would be. I wrote all this to ask you if you would be capable and willing to surgically remove both my amygdala in the hope that it would kill the fear response so that I can finally sleep and stop feeling adrenaline secreted in my stomach region and rush through my body constantly. If you are not capable and willing, can you please direct me to other doctors that can study me? Maybe do an MRI so they can confirm my amygdala is overactive and possibly agree to do the surgery on me.

Well, it is hormonal because the flight or fight response is active, but it cannot turn off. I feel it is because of the adrenaline being secreted from my adrenal glands. I have told several people about my condition, and most respond similarly. They tell me that I must be sleeping and it is impossible to be awake all the time. This, however, is my experience: any time I am up, I get very tired, and I close my eyes and rest for some hours during the night, but I am fully awake. I have been told of sleep misperception and stuff, but occasionally, I might not rest for the entire night, and anyone would observe that I did not sleep. I am generally very tired during the day and get headaches from not sleeping, and I feel like 20 % of what should be optimum on a usual basis. Can you tell me why someone could not remove both amygdalas? I researched where this woman, due to disease, had her entire amygdala destroyed, and she still lives and has her memory intact. Her declarative memory for emotional events is impaired, but not for neutral events. She does not have fear when she encounters dangerous situations, which is a potential problem for her, obviously, and it has gotten her into problems. But in my case, the fear response is causing me more trouble than losing it would hurt me. As for some memory deficits that would still keep everything mostly intact, I would be willing to do it.

I know how it sounds, a patient proposing brain surgery for a seemingly benign problem that appears to be a mere inconvenience. This, however, is a major problem for me, and I cannot live and enjoy my life or even have a peaceful existence. It has been eight years since it started, and it has not been good. There have been one or two psychological surgeries done in other countries that target specific areas of the brain that have some evidence of effectiveness, but they are quite rare and are only done in the most extreme circumstances. I know the world had moved on from the days of regular psychosurgery when they did lobotomies and so forth. These things were a disaster; many people lost their lives and were badly injured. They did not know much about the brain at the time and were poking around. What I am interested in I do not believe would have been attempted yet for this purpose. But I saw there was evidence that a person with PTSD could have alleviated symptoms by having one of their amygdala removed. This was discovered because there are persons with epilepsy who had it done that also had PTSD. But research is still young in this field, and no one has undergone it for the explicit purposes of PTSD. It was more of a knock-on effect of the surgery. What I am suffering from would not be PTSD, but it involves my fear response, and if the amygdala is removed, it could potentially kill the fear response, given what patient SM experiences. I am not asking someone to cut me open and do it purely because I request it. I am aware that there would be risks and unknowns about such an undertaking, but if I could get in contact with a team of specialists and maybe scientists that can research me, recognize that I am a very unique and peculiar case, confirm the source of my problem neurologically and potentially once they deem me an extreme enough case have a surgery done on me to stop the flight or fight response and allow me to get sleep. If you can put me on to any persons you know, it would be much appreciated, like researchers or medical specialists. I do not know who to contact that could even investigate my condition. I know what is happening, a stress response, but I do not know the exact neurologic mechanism in my brain. If I go under an MRI and they see my amygdala lit up and overactive, they can more confidently determine that removing it would solve the problem. PTSD is a bit different though it helped them, but people can still have a flight or fight response once one of their amygdalas is intact. If this is to work, I would need both removed.

I visited a doctor regarding this, and he reassured me that it is physiologically impossible not to sleep for eight years. He said that I will not feel rested and have no recollection of sleeping. And it is not possible to remove both amygdalae for many reasons. As my pathological condition may not have a surgical target because of functional or hormonal imbalance. He also said that the risk of surgery is more than the benefit. He said that he was not aware of any such researchers. He suggested I use my mind to modulate my fear. He also added that psychotherapy will help as well.

Please note that any psychological remedy has not and, in my opinion, cannot work. What are your suggestions on this?

Please help.

Answered by Dr. Hitesh Kumar

Hello,

Welcome to icliniq.com.

I went through your query and understood your concern.

As per your description, you might be having an anxiety disorder or an associated psychological disorder. Regarding the removal of the amygdala, I never encountered any literature mentioning surgical removal of the amygdala for the treatment of anxiety or psychological problem. Though if any research trial for this gets approval, someone may enlist patients for that trial, with due consent. And any surgical procedure, if not approved medically, no surgeon will attempt on an experimental basis on a patient's request.

Among surgical treatments, one possibility can be "deep brain stimulation," which has been under trial for severe depression, obsessive compulsion disorder, or anxiety disorder. In deep brain stimulation, they do not remove any part of the brain surgically. Still, they put an electrode inside a particular area in the brain and connect it with a pacemaker for intermittent stimulation.

So, I suggest you consult a psychiatrist and consider medical therapy for your symptoms.

I hope this has helped you out.

Take care.

Patient's Query

Hi doctor,

Thank you for your reply.

I understand why you say anxiety disorder, and it would be a case of anxiety disorder if I experienced anxiety at certain points during the day and then it subsided. However, it is like my brain is in locked gear. I am experiencing the fight or flight response every second of the day, and talking does not help. You could tell me that the experience I had with the man who told me I could not calm my mind should not have any bearing on me now or that it is nothing to be afraid of. No matter how it is rationalized, my mind keeps telling my brain that there is a threat. It has been happening now for over eight to nine years. I will not be able to fix this problem with psychological or psychiatric help. I need the part of the brain causing the effect to be removed. I looked into it, and there was a team in another country treating epilepsy patients that saw the effect of removing one amygdala in patients who also had PTSD. They did not do the surgery for PTSD specifically because, as you say, it would be experimental, but a lessening of their comorbid PTSD symptoms was experienced.

I would not just need one amygdala removed; I have to get whatever is causing the effect to be removed entirely, so I think both the amygdala has to be removed because the stress response is happening to me automatically and constantly. I do not get a break, and once I can continue to have a fight or flight or stress response, it will continue to happen. Do you know of any doctors who might be able to remove the amygdala? They do it for epilepsy patients. Maybe I can be studied, and considering my severe symptoms, they might agree to do it on me. I was looking into stereotactic laser ablation or laser interstitial thermal therapy.

Please help.

Answered by Dr. Hitesh Kumar

Hi,

Welcome back to icliniq.com.

I know many neurosurgeons doing epilepsy surgery and removing the part of the brain which is the focus of generating recurrent seizures. But none will remove the bilateral amygdala for psychological symptoms on your request. You can try to meet neurosurgeons personally at your place and discuss the issue with them in detail. There may be differences in laws pertaining to medical practices in every country. If the law is more lenient in your place, maybe you can find some neurosurgeon to do surgery on you as you want.

I hope this has helped you out.

Take care.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hitesh Kumar
Dr. Hitesh Kumar

Neurology

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