179. DBS for Schizophrenia: What is the Evidence?

Abstract

Overall Abstract: Schizophrenia is a common and severe neuropsychiatric disorder of unknown etiology. Dorsolateral prefrontal cortex (DLPFC) and its connection through mediodorsal thalamus have been implicated in decreased cortical dopamine and schizophrenia pathology. Negative symptoms, such as social withdrawal and general lack of motivation and engagement, are prominent in 20%–40% of patients with schizophrenia and have been attributed to aberrancies in the reward system of the ventral striatum via lowering of dopaminergic tone in nucleus accumbens (NAc). Some success has been reported in alleviating negative symptoms of schizophrenia through high-frequency repetitive magnetic stimulation of the left DLPFC. Case reports provide support for capsulotomy and deep brain stimulation of NAc in the treatment of psychosis, in the reduction of negative symptoms, and in improvement of motivation. Converging evidence supporting the targeting of NAc with reversible, modifiable deep brain stimulation, to modulate cortico-striatal-thalamo-cortical circuitry, and thereby treat symptoms of schizophrenia, will be discussed.