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Deep brain stimulation for psychiatric disorders — state of the art

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Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 34))

Abstract

A substantial number of patients suffering from severe neuropsychiatric disorders do not respond to conventional therapeutic approaches. Results from functional neuroimaging research and the development of neuromodulatory treatments lead to novel putative strategies. Recently, one of those methods, deep brain stimulation (DBS) has been applied in selected patient with major depression and obsessive-compulsive disorder (OCD) and major depression.

We summarize in this review, the state of art of knowledge about the neurobiology of depression and OCD and historical treatment methods. Principles of DBS and reasons for the use of DBS in neuropsychiatry are discussed. Different targets have been chosen in a hypothesis-guided way and first results have demonstrated that DBS might be able to modulate dysfunctional neural networks in both major depression and OCD. Although DBS is a unique and promising method for otherwise treatment resistant psychiatric patients, mandatory treatment standards have to be applied for patient and target selection. Therefore, a distinct focus of this review lies on ethical aspects for DBS in neuropsychiatric disorders.

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References

  1. Abelson JL, Curtis GC, et al. (2005) Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry 57(5): 510–16.

    Article  PubMed  Google Scholar 

  2. Adams JE, Hosobuchi Y, et al. (1974) Stimulation of internal capsule for relief of chronic pain. J Neurosurg 41(6): 740–44

    Article  CAS  PubMed  Google Scholar 

  3. Anderson D, Ahmed A (2003) Treatment of patients with intractable obsessive-compulsive disorder with anterior capsular stimulation. Case report. J Neurosurg 98(5): 1104–08

    Article  PubMed  Google Scholar 

  4. Andrews JM, Nemeroff CB (1994) Contemporary management of depression. Am J Med 97(6A): 24S–32S

    Article  CAS  PubMed  Google Scholar 

  5. Aouizerate B, Cuny E, et al. (2004) Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report. J Neurosurg 101: 574–75

    Article  Google Scholar 

  6. Appelbaum PS, Grisso T, et al. (1999) Competence of depressed patients for consent to research. Am J Psychiatry 156(9): 1380–84

    CAS  PubMed  Google Scholar 

  7. Baxter LR (1990) Brain imaging as a tool in establishing a theory of brain pathology in obsessive compulsive disorder. J Clin Psychiatry 51 Suppl: 22–5; discussion 26

    Google Scholar 

  8. Baxter LRJ, Clark EC, et al. (2001) Cortical-subcortical systems in the mediation of OCD: Modeling the brain’s mediation of a classic “neurosis”. In: Lichter DG, Cummings JL (eds) Frontal-subcortical circuits in psychiatric and neurological disorders. Guilford Press, New York, pp 207–30

    Google Scholar 

  9. Belmaker RH, Agam G (2008) Major depressive disorder. N Engl J Med 358(1): 55–68

    Article  CAS  PubMed  Google Scholar 

  10. Benabid AL, Pollak P, et al. (1987) Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 50(1–6): 344–46

    CAS  PubMed  Google Scholar 

  11. Berton O, Nestler EJ (2006) New approaches to antidepressant drug discovery: beyond monoamines. Nat Rev Neurosci 7: 137–51

    Article  CAS  PubMed  Google Scholar 

  12. Beurrier C, Bioulac B, et al. (2001) High-frequency stimulation produces a transient blockade of voltage-gated currents in subthalamic neurons. J Neurophysiol 85(4): 1351–56

    CAS  PubMed  Google Scholar 

  13. Binder DK, Iskandar BJ (2000) Modern neurosurgery for psychiatric disorders. Neurosurgery 47(1): 9–21; discussion 21–3

    Article  CAS  PubMed  Google Scholar 

  14. Bewernick et al. (in preparation)

    Google Scholar 

  15. Dostrovsky JO, Levy R, et al. (2000) Microstimulation-induced inhibition of neuronal firing in human globus pallidus. J Neurophysiol 84(1): 570–74

    CAS  PubMed  Google Scholar 

  16. Ferrao YA, Diniz JB, et al. (2007) Resistance and refractoriness in obsessive-compulsive disorder. Rev Bras Psiquiatr 29(Suppl 2): S66–76

    Google Scholar 

  17. Fins JJ (2003) From psychosurgery to neuromodulation and palliation: history’s lessons for the ethical conduct and regulation of neuropsychiatric research. Neurosurg Clin N Am 14(2): 303–19, ix–x

    Article  PubMed  Google Scholar 

  18. Fontaine D, Mattei V, et al. (2004) Effect of subthalamic nucleus stimulation on obsessive-compulsive disorder in a patient with Parkinson disease. Case report. J Neurosurg 100(6): 1084–86

    Article  PubMed  Google Scholar 

  19. Ford PJ (2007) Neurosurgical implants: clinical protocol considerations. Camb Q Healthe Ethics 16(3): 308–11

    Google Scholar 

  20. Fuchs T (2006) Ethical issues in neuroscience. Current opinion in Psychiatry 19: 600–07

    Article  PubMed  Google Scholar 

  21. Gabriels L, Cosyns P, et al. (2003) Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: psychopathological and neuropsychological outcome in three cases. Acta Psychiatr Scand 107(4): 275–82

    Article  CAS  PubMed  Google Scholar 

  22. Gildenberg PL (2005) Evolution of neuromodulation. Stereotact Funct Neurosurg 83(2–3): 71–9

    Article  PubMed  Google Scholar 

  23. Greenberg B, Malone D (2007) Preliminary results from DBS multicenter study in depression. Providence, RI, personal communication.

    Google Scholar 

  24. Greenberg BD, Malone DA, et al. (2006) Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology 31(11): 2384–93

    Article  PubMed  Google Scholar 

  25. Greenberg BD, Price LH, et al. (2003) Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin N Am 14(2): 199–212

    Article  PubMed  Google Scholar 

  26. Hardesty DE, Sackeim HA (2007) Deep brain stimulation in movement and psychiatric disorders. Biol Psychiatry 61(7): 831–35

    Article  PubMed  Google Scholar 

  27. Hilker R, Voges J, et al. (2002) Deep brain stimulation of the subthalamic nucleus versus levodopa challenge in Parkinson’s disease: measuring the on-and off-conditions with FDG-PET. J Neural Transm 109(10): 1257–64

    Article  CAS  PubMed  Google Scholar 

  28. Jech R, Urgosik D, et al. (2001) Functional magnetic resonance imaging during deep brain stimulation: a pilot study in four patients with Parkinson’s disease. Mov Disord 16(6): 1126–32

    Article  CAS  PubMed  Google Scholar 

  29. Jiménez F, Velasco F, et al. (2005) A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle. J Neurosurg 57: 585–93

    Article  Google Scholar 

  30. Keller MB, Baker LA (1992) The clinical course of panic disorder and depression. J Clin Psychiatry 53 (Suppl): 5–8

    PubMed  Google Scholar 

  31. Keller MB, Lavori PW, et al. (1992) Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry 49(10): 809–16

    CAS  PubMed  Google Scholar 

  32. Kringelbach ML, Jenkinson N, et al. (2007) Translational principles of deep brain stimulation. Nat Rev Neurosci 8(8): 623–35

    Article  CAS  PubMed  Google Scholar 

  33. Kühn, J, Huff W, et al. (2007) Tiefenhimstimulation bei psychiatrischen Erkrankungen. Fortschritte der Neurologie und Psychiatrie 75: 447–57

    Article  Google Scholar 

  34. Larson PS (2008) Deep brain stimulation for psychiatric disorders. Neurotherapeutics 5(1): 50–8

    Article  PubMed  Google Scholar 

  35. Lipsman N, Neimat JS, et al. (2007) Deep brain stimulation for treatment-refractory obsessive-compulsive disorder: the search for a valid target. Neurosurgery 61(1): 1–11; discussion 11–3

    Article  PubMed  Google Scholar 

  36. Mallet L, Mesnage V, et al. (2002) Compulsions Parkinson’s disease, and stimulation. Lancet 360(9342): 1302–04

    Article  PubMed  Google Scholar 

  37. Mann JJ (2005) The medical management of depression. N Engl J Med 353(17): 1819–34

    Article  CAS  PubMed  Google Scholar 

  38. Mayberg HS (1997) Limbic-cortical dysregulation: a proposed model of depression. J Neuropsychiatry 9: 471–81

    CAS  Google Scholar 

  39. Mayberg HS, AM. Lozano, et al. (2005) Deep brain stimulation for treatment-resistant depression. Neuron 45: 651–60

    Article  CAS  PubMed  Google Scholar 

  40. McIntyre CC, Savasta M, et al. (2004) Uncovering the mechanism (s) of action of deep brain stimulation: activation, inhibition, or both. Clin Neurophysiol 115(6): 1239–48

    Article  PubMed  Google Scholar 

  41. Mink JW, Walkup J, et al. (2006) Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord 21(11): 1831–38

    Article  PubMed  Google Scholar 

  42. Moniz E (1954) I succeeded in performing the prefrontal leukotomy. J Clin Exp Psychopathol 15(4): 373–79

    CAS  PubMed  Google Scholar 

  43. Murray CJ, Lopez AD (1997) Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 349(9063): 1436–42

    Article  CAS  PubMed  Google Scholar 

  44. Nuttin B, Cosyns P, et al. (1999) Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet 354(9189): 1526

    Article  CAS  PubMed  Google Scholar 

  45. Nuttin B, Gybels J, et al. (2002) Deep brain stimulation for psychiatric disorders. Neurosurgery 51(2): 519

    Article  Google Scholar 

  46. Nuttin BJ, Gabriels LA, et al. (2003) Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery 52(6): 1263–72; discussion 1272–74

    Article  PubMed  Google Scholar 

  47. Price BH, Baral I, et al. (2001) Improvement in severe self-mutilation following limbic leucotomy: a series of 5 consecutive cases. J Clin Psychiatry 62(12): 925–32

    CAS  PubMed  Google Scholar 

  48. Ranck JB Jr (1975) Which elements are excited in electrical stimulation of mammalian central nervous system: a review. Brain Res 98(3): 417–40

    Article  PubMed  Google Scholar 

  49. Rush AJ, Trivedi MH, et al. (2006) Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am J Psychiatry 163(11): 1905–17

    Article  PubMed  Google Scholar 

  50. Sartorius A, Henn FA (2007) Deep brain stimulation of the lateral habenula in treatment resistant major depression. Med Hypotheses 69(6): 1305–08

    Article  PubMed  Google Scholar 

  51. Schlaepfer T, Bewernick B (2006) Deep brain stimulation for treatment-refractory major depression. http://clinicaltrials.gov/ct2/show/NCT00122031?term=deep+brain+stimulation+depression&rank=6, from http://clinicaltrials.gov/ct2/show/NCT00122031?term=deep+brain+stimulation+depression&rank=6

    Google Scholar 

  52. Schlaepfer T, Frick C, et al. (2008) Stimulation for depression: efficacy and safety in a European study. Vagus Nerve 38: 651–62

    CAS  Google Scholar 

  53. Schlaepfer TE (2006) Deep brain stimulation. Neuromodulation therapies for psychiatric disorder and their ethical implications. Akademie — Brief der Europäischen Akademie zur Erforschung von Folgen wissenschaftlich-technischer. Entwicklungen 65: 1–3

    Google Scholar 

  54. Schlaepfer TE, Cohen MX, et al. (2007) Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 33: 368–77

    Article  PubMed  Google Scholar 

  55. Schlaepfer TE, Lieb K (2005) Deep brain stimulation for treatment of refractory depression. Lancet 366(9495): 1420–22

    Article  PubMed  Google Scholar 

  56. Schnitzler A, Gross J (2005) Normal and pathological oscillatory communication in the brain. Nat Rev Neurosci 6(4): 285–96

    Article  CAS  PubMed  Google Scholar 

  57. Shelton RC (2007) The molecular neurobiology of depression. Psychiatr Clin N Am 30(1): 1–11

    Article  Google Scholar 

  58. Sher L (2004) Daily hassles, cortisol, and the pathogenesis of depression. Med Hypotheses 62(2): 198–202

    Article  CAS  PubMed  Google Scholar 

  59. Stefani A, Fedele E, et al. (2006) Deep brain stimulation in Parkinson’s disease patients: biochemical evidence. J Neural Transm Suppl (70): 401–08

    Google Scholar 

  60. Stefurak T, Mikulis D, et al. (2003) Deep brain stimulation for Parkinson’s disease dissociates mood and motor circuits: a functional MRI case study. Mov Disord 18(12): 1508–16

    Article  PubMed  Google Scholar 

  61. Stein DJ (2002) Obsessive-compulsive disorder. Lancet 360(9330): 397–405

    Article  PubMed  Google Scholar 

  62. Sturm V, Lenartz D, et al. (2003) The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive-and anxiety-disorders. J Chem Neuroanat 26(4): 293–99

    Article  PubMed  Google Scholar 

  63. Synofzik M (2005) Interventionen zwischen Gehirn und Geist: eine ethische Analyse der neuen Möglichkeiten der Neurowissenschaften. Fortschritte der Neurologie und Psychiatrie: 1–9

    Google Scholar 

  64. Synofzik M (2007) Eingriffe in die Grundlagen der Persönlichkeit: eine praxisorientierte ethische Analyse von Neuropharmaka und Tiefhirnstimulation. Ethik in der Medizin 132: 1–4

    Google Scholar 

  65. Yurgelun-Todd DA, Sava S, et al. (2007) Mood disorders. Neuroimag Clin N Am 17(4): 511–21, ix

    Article  Google Scholar 

  66. Zucker RS, Regehr WG (2002) Short-term synaptic plasticity. Annu Rev Physiol 64: 355–405

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Brain Stimulation Group, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Germany

    T. E. Schläpfer & B. H. Bewernick

  2. Departments of Psychiatry and Mental Health, The Johns Hopkins University, MD, USA

    T. E. Schläpfer & B. H. Bewernick

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  1. T. E. Schläpfer
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  2. B. H. Bewernick
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Schläpfer, T.E., Bewernick, B.H. (2009). Deep brain stimulation for psychiatric disorders — state of the art. In: Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 34. Springer, Vienna. https://doi.org/10.1007/978-3-211-78741-0_2

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  • DOI: https://doi.org/10.1007/978-3-211-78741-0_2

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-78740-3

  • Online ISBN: 978-3-211-78741-0

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