Deep Brain Stimulation for Treatment-Resistant Schizophrenia: A Systematic Review

Abstract

Background: Resistance to treatment characterizes a substantial portion of patients with schizophrenia. Without adequate symptom control from medication, these patients are left with few therapeutic options. Objective: Given the recent success of Deep Brain Stimulation (DBS) in treatment-refractory neuropsychiatric disorders such as depression, obsessivecompulsive disorder, substance use disorder, and Tourette syndrome, we reviewed the existing evidence for DBS in schizophrenia. Methods: We searched PubMed and MEDLINE for articles and conducted a systematic review on DBS as a treatment for schizophrenia in line with the PRISMA-P 2020 guidelines. Results: After the search and screening process, we reviewed a total of three articles with eleven patients implanted. The nucleus accumbens (n = 3), subgenual anterior cingulate cortex (n = 4), habenula (n = 2), and substantia nigra pars reticulata (n = 1) were all targeted for stimulation. Stimulation resulted in symptom reduction on respective outcome measures in nine of ten patients stimulated (one patient was explanted without stimulation). There were ten adverse events across the eleven procedures and five of these were deemed serious adverse events, comparable to other reports of DBS. Three of these events occurred in the same patient, while one event coincided with a patient’s discontinuation of their own antipsychotic regimen. None resulted in permanent harm. Conclusion: Despite a limited experience, DBS is likely safe, and potentially effective in patients with refractory schizophrenia. Further investigation is necessary to establish ideal targets for stimulation.