Deep Brain Stimulation in Psychiatry

Bilge, Mustafa Taha; Gosai, Aishwarya; Widge, Alik S.

doi:10.1016/j.psc.2018.04.003

Cited by 26 publications

(12 citation statements)

References 83 publications

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“…DBS therapy requires fine tuning of individual patients’ stimulation parameters, altering the applied electric field to engage a target circuit 7 . A challenge in mental illness is that there is no objective biomarker of that engagement, and thus no rigorous definition of “effective dose” 8,9 . The brain’s response to electrical stimulation has been studied for decades, from simple preparations to complex modeling 7,10,11 .…”

Section: Introductionmentioning

confidence: 99%

“…Despite those studies, the precise therapeutic mechanism of DBS’ high-frequency stimulation is a topic of frequent debate. Current theories focus around resetting of abnormal oscillatory activity, which may alter information transmission in distributed circuits 8,12 . This uncertainty suggests that some patients who did not respond in clinical trials likely did not receive an active dose of the study intervention.…”

Section: Introductionmentioning

confidence: 99%

“…If DBS’ mechanisms were better understood, it might be possible to redesign the clinical approach around physiology. Stimulation could be titrated to achieve a specific and relatively immediate electrophysiologic change, with symptom relief emerging in response to that change 4,8,13,14 . Thus, understanding mechanisms of action at the neurophysiologic level is a critical next step for developing DBS as a psychiatric treatment.…”

Section: Introductionmentioning

confidence: 99%

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Deep brain stimulation of the internal capsule enhances human cognitive control and prefrontal cortex function

et al. 2019

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Deep brain stimulation (DBS) is a circuit-oriented treatment for mental disorders. Unfortunately, even well-conducted psychiatric DBS clinical trials have yielded inconsistent symptom relief, in part because DBS’ mechanism(s) of action are unclear. One clue to those mechanisms may lie in the efficacy of ventral internal capsule/ventral striatum (VCVS) DBS in both major depression (MDD) and obsessive-compulsive disorder (OCD). MDD and OCD both involve deficits in cognitive control. Cognitive control depends on prefrontal cortex (PFC) regions that project into the VCVS. Here, we show that VCVS DBS’ effect is explained in part by enhancement of PFC-driven cognitive control. DBS improves human subjects’ performance on a cognitive control task and increases theta (5–8Hz) oscillations in both medial and lateral PFC. The theta increase predicts subjects’ clinical outcomes. Our results suggest a possible mechanistic approach to DBS therapy, based on tuning stimulation to optimize these neurophysiologic phenomena.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Deep brain stimulation of the internal capsule enhances human cognitive control and prefrontal cortex function

et al. 2019

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“…In Parkinson’s disease, pathological beta band activity may represent an essential biomarker for adaptive stimulation (Moraud et al, 2018). However, biomarker identification in psychiatric disease states will prove to be more challenging due to clinical heterogeneity, and may be dependent on identifying commonalities among disease phenotypes (Bilge et al, 2018). The implantation of DBS electrodes allows for both acute (microelectrode) and chronic (macroelectrode) recordings to identify potential electrophysiological biomarkers in psychiatric disease states.…”

Section: Future Directionsmentioning

confidence: 99%

Evolution in the Treatment of Psychiatric Disorders: From Psychosurgery to Psychopharmacology to Neuromodulation

et al. 2019

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The treatment of psychiatric patients presents significant challenges to the clinical community, and a multidisciplinary approach to diagnosis and management is essential to facilitate optimal care. In particular, the neurosurgical treatment of psychiatric disorders, or “psychosurgery,” has held fascination throughout human history as a potential method of influencing behavior and consciousness. Early evidence of such procedures can be traced to prehistory, and interest flourished in the nineteenth and early twentieth century with greater insight into cerebral functional and anatomic localization. However, any discussion of psychosurgery invariably invokes controversy, as the widespread and indiscriminate use of the transorbital lobotomy in the mid-twentieth century resulted in profound ethical ramifications that persist to this day. The concurrent development of effective psychopharmacological treatments virtually eliminated the need and desire for psychosurgical procedures, and accordingly the research and practice of psychosurgery was dormant, but not forgotten. There has been a recent resurgence of interest for non-ablative therapies, due in part to modern advances in functional and structural neuroimaging and neuromodulation technology. In particular, deep brain stimulation is a promising treatment paradigm with the potential to modulate abnormal pathways and networks implicated in psychiatric disease states. Although there is enthusiasm regarding these recent advancements, it is important to reflect on the scientific, social, and ethical considerations of this controversial field.

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“…With the emergence of studies including adaptive model, and with the improvement of the quality of the pacemakers (expected to be fully and automatically programmable, compatible with biomarker variations, and flexible in stimulation type and pattern), a closed loop model could be considered in a next future in neurology 71. But concerning psychiatry, it remained more of a vision than a near-term guarantee 73. Indeed, the researchers first need to determine endophenotypes to identify candidate predictive algorithms for adjustments settings; which could be transferred to an automatic controller in the DBS system itself (Development of Adaptive Deep Brain Stimulation for OCD, NCT03457675).…”

Section: Perspectivesmentioning

confidence: 99%

<p>Deep brain stimulation in the treatment of obsessive-compulsive disorder: current perspectives</p>

Tastevin¹,

Spatola²,

Régis³

et al. 2019

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Deep brain stimulation (DBS) is a neuro-psychosurgical technique widely accepted in movement disorders, such as Parkinson’s disease. Since 1999, DBS has been explored for severe, chronic and treatment-refractory psychiatric diseases. Our review focuses on DBS in obsessive-compulsive disorder (OCD), considered as a last treatment resort by most of learned societies in psychiatry. Two main stimulation areas have been studied: the striatal region and the subthalamic nucleus. But, most of the trials are open-labeled, and the rare controlled ones have failed to highlight the most efficient target. The recent perspectives are otherwise encouraging. Indeed, clinicians are currently considering other promising targets. A case series of 2 patients reported a decrease in OCD symptoms after DBS in the medial forebrain bundle and an open-label study is exploring bilateral habenula stimulation. New response criteria are also investigating such as quality of life, or subjective and lived-experience. Moreover, first papers about cost-effectiveness which is an important criterion in decision making, have been published. The effectiveness of tractography-assisted DBS or micro-assisted DBS is studying with the aim to improve targeting precision. In addition, a trial involving rechargeable pacemakers is undergoing because this mechanism could be efficient and have a positive impact on cost-effectiveness. A recent trial has discussed the possibility of using combined cognitive behavioral therapy (CBT) and DBS as an augmentation strategy. Finally, based on RDoc Research, the latest hypotheses about the understanding of cortico-striato-thalamo-cortical circuits could offer new directions including clinical predictors and biomarkers to perform adaptive closed-loop systems in the next future.

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Deep Brain Stimulation in Psychiatry

Cited by 26 publications

References 83 publications

Deep brain stimulation of the internal capsule enhances human cognitive control and prefrontal cortex function

Deep brain stimulation of the internal capsule enhances human cognitive control and prefrontal cortex function

Evolution in the Treatment of Psychiatric Disorders: From Psychosurgery to Psychopharmacology to Neuromodulation

<p>Deep brain stimulation in the treatment of obsessive-compulsive disorder: current perspectives</p>

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