Abstract
Deep brain stimulation (DBS) is currently under research for the treatment of psychiatric disorders, e.g., obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Since the application of DBS in psychiatry has been in use for about 20 years, it is necessary to evaluate its long-term use now. A main issue in the long-term treatment of DBS concerns the effects of a discontinuation of stimulation due to intended as well as unintended reasons. In this contribution, the literature describing discontinuation effects following DBS in OCD and TRD is reviewed. Furthermore, a patient is reported in depth who experienced an unintended discontinuation of supero-lateral medial forebrain bundle (slMFB) DBS for TRD. In this case, the battery was fully depleted without the patient noticing. DBS had led to a sustained response for seven years before discontinuation of stimulation for just several weeks caused a progressive worsening of depression. Altogether, the rapid occurrence of symptom worsening, the absence of a notification about the stimulation status and the difficulties to recapture antidepressant response represent important safety aspects. For a further understanding of the described effects, time courses until worsening of depression as well as biological mechanisms need to be investigated in double-blind controlled trials.
Highlights
Deep brain stimulation (DBS) of the nucleus subthalamicus (STN) was first introduced in 1994 as a treatment for Parkinson’s disease (PD) [1,2]
This paper aims to give an overview of the effects of DBS discontinuation in psychiatry and to report another single case that experienced an unintended discontinuation of supero-lateral medial forebrain bundle DBS after seven years of continuous stimulation
As the effects of DBS discontinuation often are described as part of larger RCTs, there were only a small number of articles that were found with the above-described keywords
Summary
Deep brain stimulation (DBS) of the nucleus subthalamicus (STN) was first introduced in 1994 as a treatment for Parkinson’s disease (PD) [1,2]. Psych 2020, 2 necessary in order to maintain clinical effects of DBS. Motor symptoms such as tremor, bradykinesia, rigidity and axial signs occurred acutely after the cessation of STN DBS [4]. After the re-onset of stimulation, the described symptoms diminished acutely. This effect is described as a two-way effect, meaning a change of symptoms caused by the stimulation that works in both directions (improvement with onset of stimulation as well as aggravation with offset of stimulation). In PD, discontinuation of stimulation should be regarded as a safety issue because it has been associated with rebound symptoms requiring emergency care. It seems probable that PD patients may need permanent stimulation for the rest of their lives [9]
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