Abstract
Chronic Major depression is one of the most debilitating psychiatric disorders ; 8-13% of patients are treatment resistant. DBS has been applied to the following targets: Subcallosal cingulate gyrus (Brodmann 25a), Ventral Capsule and Ventral Striatum (VC/VS), Nucleus Accumbens (NA), Inferior thalamic Peduncle (ITP) Rostral Cingulate Cortex. In the contrary to neurological diseases, for major depression there is not a single pathological target structure; several brain structures presumably play different roles in the development as well as in the maintenance of symptoms; some targets are in close anatomical or functional relationship (neural networks) and an overlap of effect is plausible; different target might manipulate the pathological network at different nodes. This overview summarizes research on the mechanisms of brain networks with respect to psychiatric diseases and highlights the role of the reward system in DBS for patients with treatment-resistant depression.
Highlights
Psychosurgery was first introduced in 1930s by Moniz with the prefrontal leucotomy, a surgical method that disrupted afferent/efferent pathways of the frontal lobe and this method was further developed in the transorbital frontal lobotomy by Freeman
Several ablative techniques were used for treatment of Major Depression (MD) such as anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy and limbic leucotomy [1,2]
The authors studied the percentage of patients who achieved a response (50% or greater reduction in the HAMD-17) or remission after Deep Brain Stimulation (DBS)
Summary
Psychosurgery was first introduced in 1930s by Moniz with the prefrontal leucotomy, a surgical method that disrupted afferent/efferent pathways of the frontal lobe and this method was further developed in the transorbital frontal lobotomy by Freeman. Several ablative techniques were used for treatment of Major Depression (MD) such as anterior cingulotomy, anterior capsulotomy, subcaudate tractotomy and limbic leucotomy [1,2]. Functional imaging has played significant role in the diffusion of DBS. Another incentive was the fact that effective but irreversible ablative interventions could be emulated using DBS with a focused, fully reversible and treatable technique [3]. In 1999 there was the first report of use of DBS for a psychiatric disorder (anterior capsule DBS for OCD) [4]
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