Abstract
Deep brain stimulation (DBS) has been offered to patients suffering of severe and resistant neuropsychiatric disorders like Obsessive Compulsive Disorder (OCD), Gilles de la Tourette Syndrome (TS) and Major Depression (MDD). Modulation of several targets within the cortico-striato-thalamo-cortical circuits can lead to a decrease of symptom severity in those patients. This review focuses on the recent clinical outcomes in DBS in psychiatric disorders. Studies on OCD and TS are now focusing on the long-term effects of DBS, with encouraging results regarding not only the decrease of symptoms, but also quality of life. They also highlighted efficient adjuvant techniques, like cognitive and behavioural therapy and support programs, to enhance an often-partial response to DBS. The application of DBS for MDD is more recent and, despite encouraging initial open-label studies, two large randomised studies have failed to demonstrate an efficacy of DBS in MDD according to evidence-based medicine criteria. Last years, DBS was also tested in other resistant psychiatric disorders, as anorexia nervosa and addiction, with encouraging preliminary results. However, today, no target – whatever the disease – can meet the criteria for clinical efficacy as recently defined by an international committee for neurosurgery for psychiatric disorders. Consequently, DBS in psychiatric disorders still needs to proceed within the frame of clinical trials.
Highlights
Deep brain stimulation (DBS) is a neurosurgical technique based on the stereotactic implantation of quadripolar electrodes delivering high-frequency current in a specific subcortical or deep cortical structure
Based on the efficacy of previous lesional surgeries[1], the first targets were the anterior limb of internal capsule (ALIC)[2] in obsessive-compulsive disorder (OCD) and the centromedian-parafascicular complex (CM-Pf) in TS3; 3 years later, an important decrease of comorbid OCD symptoms was reported in two parkinsonian patients stimulated in the subthalamic nucleus (STN)[4]
The same year, given the effects of globus pallidus internus (GPi) DBS on hyperkinesia in Parkinson’s disease (PD), a patient with Tourette syndrome (TS) was stimulated in the postero-ventral GPi and showed postoperative clinical improvement[5]
Summary
F1000 Faculty Reviews are written by members of the prestigious F1000 Faculty. They are commissioned and are peer reviewed before publication to ensure that the final, published version is comprehensive and accessible. The reviewers who approved the final version are listed with their names and affiliations. Any comments on the article can be found at the end of the article
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