Deep Brain Stimulation for Psychiatric Disorders

Kuhn, Jens; Gründler, Theo O. J.; Lenartz, Doris; Sturm, Volker; Klosterkötter, Joachim; Huff, Wolfgang

doi:10.3238/arztebl.2010.0105

Cited by 49 publications

(43 citation statements)

References 82 publications

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“…Mania is one of the most concerning negative neuropsychiatric effects resulting from DBS (89), but paradoxical worsening of anxiety and depression has also been reported (151).Feelings of suicidality can emerge; however, it is unclear whether these feeling are the result of the stimulation itself or of an augmentation of a preimplantation suicidality. Feelings of irritability and anger have been reported (53,136,152). Cognitive dysfunction at high amplitudes has been observed with BA 25 DBS along with the occurrence of paradoxical worsening of depressive symptoms (21).…”

Section: Positive and Negative Effects Of Dbs Positive Neuropsychiatrmentioning

confidence: 99%

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Deep brain stimulation (DBS) at the interface of neurology and psychiatry

Williams¹,

Okun²

2013

J. Clin. Invest.

111

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Section: Positive and Negative Effects Of Dbs Positive Neuropsychiatrmentioning

confidence: 99%

“…Limbic STN DBS for OCD has been associated with hypomania, anxiety, impulsiveness, depression symptoms, and obsessive-compulsive thoughts (ref. 152 and see Table 5). …”

Section: Positive and Negative Effects Of Dbs Positive Neuropsychiatrmentioning

confidence: 99%

Deep brain stimulation (DBS) at the interface of neurology and psychiatry

Williams¹,

Okun²

2013

J. Clin. Invest.

111

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“…Until today, a considerable number of investigations have demonstrated beneficial clinical effects of DBS in depression, obsessive-compulsive disorder (OCD), and Tourette's syndrome, respectively. Hence, DBS has become an approved treatment option in OCD under the humanitarian device exemption, and current discussions aim to extend its therapeutic scope even further (Kuhn et al, 2010). Besides others, current approaches address addiction due to psychotropic substances and Alzheimer's disease, both representing disorders of great socioeconomic relevance (Kuhn et al, submitted;Kuhn et al, 2007;Laxton et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation in Schizophrenia

et al. 2014

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Deep brain stimulation (DBS) has successfully advanced treatment options of putative therapy-resistant neuropsychiatric diseases. Building on this strong foundation more and more mental disorders in the stadium of therapy-resistance are considered as possible indications for DBS. Especially schizophrenia with its associated severe and difficult to treat symptoms is gaining attention. This attention demands critical questions regarding the assumed mechanisms of DBS and its possible influence on the supposed pathophysiology of schizophrenia. Here we synoptically compare current approaches and theories of DBS and discuss the feasibility of DBS in schizophrenia as well as the transferability from other psychiatric disorders successfully treated with DBS. For this we consider recent advances in animal models of schizophrenic symptoms, results regarding the influence of DBS on dopaminergic transmission as well as data concerning neural oscillation and synchronization. In conclusion the use of DBS for some symptoms of schizophrenia seems to be a promising approach, but the lack of a comprehensive theory of the mechanisms of DBS as well as its impact on schizophrenia might void the use of DBS in schizophrenia at this point.

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“…10,11 DBS was initially developed for movement disorders and has only recently been applied in neuropsychiatry; 56,99 it was the observation of psychiatric side effects after STN DBS in patients with PD that prompted DBS trials for psychiatric disorders; 57,87 and early proponents of surgical intervention for psychiatric illness failed to adopt a multidisciplinary approach with neurosurgeons often working "in isolation" from other specialists.…”

mentioning

confidence: 99%

“…Common beliefs conveyed by contemporary literature on DBS include the following: DBS was "invented by Benabid and coworkers;" 57,87,99 the observation that highfrequency stimulation often mimics the clinical effects of lesional surgery was first made in 1987;…”

mentioning

confidence: 99%

Deep brain stimulation between 1947 and 1987: the untold story

Hariz

Blomstedt

Zrinzo

2010

FOC

198

120

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Deep brain stimulation (DBS) is the most rapidly expanding field in neurosurgery. Movement disorders are well-established indications for DBS, and a number of other neurological and psychiatric indications are currently being investigated. Numerous contemporary opinions, reviews, and viewpoints on DBS fail to provide a comprehensive account of how this method came into being. Misconceptions in the narrative history of DBS conveyed by the wealth of literature published over the last 2 decades can be summarized as follows: Deep brain stimulation was invented in 1987. The utility of high-frequency stimulation was also discovered in 1987. Lesional surgery preceded DBS. Deep brain stimulation was first used in the treatment of movement disorders and was subsequently used in the treatment of psychiatric and behavioral disorders. Reports of nonmotor effects of subthalamic nucleus DBS prompted its use in psychiatric illness. Early surgical interventions for psychiatric illness failed to adopt a multidisciplinary approach; neurosurgeons often worked “in isolation” from other medical specialists. The involvement of neuro-ethicists and multidisciplinary teams are novel standards introduced in the modern practice of DBS for mental illness that are essential in avoiding the unethical behavior of bygone eras. In this paper, the authors examined each of these messages in the light of literature published since 1947 and formed the following conclusions. Chronic stimulation of subcortical structures was first used in the early 1950s, very soon after the introduction of human stereotaxy. Studies and debate on the stimulation frequency most likely to achieve desirable results and avoid side effects date back to the early days of DBS; several authors advocated the use of “high” frequency, although the exact frequency was not always specified. Ablative surgery and electrical stimulation developed in parallel, practically since the introduction of human stereotactic surgery. The first applications of both ablative surgery and chronic subcortical stimulation were in psychiatry, not in movement disorders. The renaissance of DBS in surgical treatment of psychiatric illness in 1999 had little to do with nonmotor effects of subthalamic nucleus DBS but involved high-frequency stimulation of the very same brain targets previously used in ablative surgery. Pioneers in functional neurosurgery mostly worked in multidisciplinary groups, including when treating psychiatric illness; those “acting in isolation” were not neurosurgeons. Ethical concerns have indeed been addressed in the past, by neurosurgeons and others. Some of the questionable behavior in surgery for psychiatric illness, including the bygone era of DBS, was at the hands of nonneurosurgeons. These practices have been deemed as “dubious and precarious by yesterday's standards.”

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Deep Brain Stimulation for Psychiatric Disorders

Cited by 49 publications

References 82 publications

Deep brain stimulation (DBS) at the interface of neurology and psychiatry

Deep brain stimulation (DBS) at the interface of neurology and psychiatry

Deep Brain Stimulation in Schizophrenia

Deep brain stimulation between 1947 and 1987: the untold story

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