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Preoperative Evaluation and Postoperative Follow-up of Deep Brain Stimulation for Psychiatric Disorders

  • Loes GabriëlsEmail author
  • Hemmings Wu
  • Bart Nuttin
Chapter

Abstract

Deep brain stimulation (DBS) is under investigation as a new treatment for an increasing number of psychiatric conditions. Candidates for DBS are treatment refractory, severely incapacitated and have a very low quality of life. Patient selection should identify candidates that obtain and retain the greatest benefit. In psychiatric care, it is evident that a psychiatric disorder does not affect patients alone, but has a profound and devastating impact on those around them. These caregivers cannot be neglected in the follow-up process, since the impact of DBS on the psychiatric symptoms of the patient will reflect on the relationships. After surgery, the search for adequate stimulation parameters and the optimization process with fluctuations in symptom severity may be burdensome. Patients may not be abandoned once the DBS procedure is performed. With improvement of symptoms, patients are less stuck in their chronic psychiatric disorder and may need help in the definition of new goals and new purposes in life.

Keywords

Psychiatric Disorder Deep Brain Stimulation Obsessive Compulsive Disorder Impulse Control Disorder Deep Brain Stimulation Surgery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Agich GJ. Reassessing autonomy in long-term care. Hastings Cent Rep. 1990;20:12–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Anita H. Relational autonomy or undue pressure? Family’s role in medical decision-making. Scand J Caring Sci. 2008;22:128–35.CrossRefGoogle Scholar
  3. 3.
    Denys D, Mantione M, Figee M, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010;67:1061–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Donchin A. Understanding autonomy relationally: toward a reconfiguration of bioethical principles. J Med Philos. 2001;26:365–86.PubMedCrossRefGoogle Scholar
  5. 5.
    Gabriëls L, Cosyns P, Nuttin B. Clinical guidance in neuromodulation: keeping track of the process and the patient. Neuromodulation. 2007;10(2):179–80.Google Scholar
  6. 6.
    Gabriëls L, Nuttin B, Cosyns P. Applicants for stereotactic neurosurgery for psychiatric disorders: role of the Flemish advisory board. Acta Psychiatr Scand. 2008;117(5):381–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Greenberg B, Gabriels L, Malone DA Jr, et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry. 2008;15(1):64–79.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Israël M, Steiger H, Kolivakis T, et al. Deep brain stimulation in the subgenual cingulate cortex for an intractable eating disorder. Biol Psychiatry. 2010;67(9):e53–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Lozano AM, Mayberg HS, Giacobbe P, et al. Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry. 2008;64(6):461–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Maley JH, Jorge E, Alvernia JE, et al. Deep brain stimulation of the orbitofrontal projections for the treatment of intermittent explosive disorder. Neurosurg Focus. 2010;29(2):E11.PubMedCrossRefGoogle Scholar
  11. 11.
    Mallet L, Polosan M, Jaafari N, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med 2008;359(20):2121–34.Google Scholar
  12. 12.
    Malone DA Jr, Dougherty DD, Rezai AR, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biol Psychiatry. 2009;65(4):267–75.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Müller UJ, Sturm V, Voges J, et al. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. Pharmacopsychiatry. 2009;42:288–92.PubMedCrossRefGoogle Scholar
  14. 14.
    Nuttin B, Gabriëls L, Cosyns P, et al. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery. 2003;52(6):1263–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Nuttin B, Wu H, Mayberg H, et al. Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders. J Neurol Neurosurg Psychiatry. 2014. doi: 10.1136/jnnp-2013-306580.
  16. 16.
    Schlaepfer TE, Cohen MX, Frick C, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology. 2008;33(2):368–77.PubMedCrossRefGoogle Scholar
  17. 17.
    Synofzik M, Schlaepfer TE. Electrodes in the brain—ethical criteria for research and treatment with deep brain stimulation for neuropsychiatric disorders. Brain Stimul. 2011;4(1):7–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Waterworth S, Luker KA. Reluctant collaborators: do patients want to be involved in decisions concerning care? J Adv Nurs. 1990;15:971–6.PubMedCrossRefGoogle Scholar
  19. 19.
    World Health Organization: Health for all by the year 2000: strategies. Geneva, Switzerland, 1980. WHO official document 173.Google Scholar

Copyright information

© Shanghai Jiao Tong University Press, Shanghai and Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.UPC KU LeuvenLeuvenBelgium
  2. 2.Laboratory of Experimental Neurosurgery and NeuroanatomyKU LeuvenLeuvenBelgium
  3. 3.University Hospitals LeuvenLeuvenBelgium

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