Deep brain stimulation (DBS) at the interface of neurology and psychiatry
The Journal of clinical investigation (Impact Factor: 13.22). 11/2013; 123(11):4546-56. DOI: 10.1172/JCI68341
Deep brain stimulation (DBS) is an emerging interventional therapy for well-screened patients with specific treatment-resistant neuropsychiatric diseases. Some neuropsychiatric conditions, such as Parkinson disease, have available and reasonable guideline and efficacy data, while other conditions, such as major depressive disorder and Tourette syndrome, have more limited, but promising results. This review summarizes both the efficacy and the neuroanatomical targets for DBS in four common neuropsychiatric conditions: Parkinson disease, Tourette syndrome, major depressive disorder, and obsessive-compulsive disorder. Based on emerging new research, we summarize novel approaches to optimization of stimulation for each neuropsychiatric disease and we review the potential positive and negative effects that may be observed following DBS. Finally, we summarize the likely future innovations in the field of electrical neural-network modulation.
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- "While DBS is currently FDA-approved for the treatment of obsessive–compulsive disorder (OCD), limited but promising results have been reported in regard to mood and cognitive disorders (Ashkan et al., 2013; Tye et al., 2009; Williams and Okun, 2013). Therefore, DBS is currently being tested for the treatment of patients who are non-responsive to all evidence-based therapies for TRD (Williams and Okun, 2013). Despite an incomplete understanding of the mechanisms involved in the therapeutic response, DBS seems to produce a significant reduction in symptoms and high rates of remission in TRD (Anderson et al., 2012). "
ABSTRACT: Despite a wide variety of therapeutic interventions for major depressive disorder (MDD), treatment resistant depression (TRD) remains to be prevalent and troublesome in clinical practice. In recent years, deep brain stimulation (DBS) has emerged as an alternative for individuals suffering from TRD not responding to combining antidepressants, multiple adjunctive strategies and electroconvulsive therapy (ECT). Although the best site for TRD-DBS is still unclear, pilot data suggests that the medial forebrain bundle (MFB) might be a key target to accomplish therapeutic efficacy in TRD patients. To explore the anatomic, electrophysiologic, neurocognitive and treatment data supporting the MFB as a target for TRD-DBS. The MFB connects multiple targets involved in motivated behavior, mood regulation and antidepressant response. Specific phenomenology associated with TRD can be linked specifically to the superolateral branch (sl) of the MFB (slMFB). TRD patients who received DBS-slMFB reported high response/remission rates with an improvement in functioning and no significant adverse outcomes in their physical health or neurocognitive performance. Discussion The slMFB is an essential component of a network of structural and functional pathways connecting different areas possibly involved in the pathogenesis of mood disorders. Therefore, the slMFB should be considered as an exciting therapeutic target for DBS therapy to achieve a sustained relief in TRD patients. There is an urgent need for clinical trials exploring DBS-slMFB in TRD. Further efforts should pursue measuring baseline pro-inflammatory cytokines, oxidative stress, and cognition as possible biomarkers of DBS-slMFB response in order to aid clinicians in better patient selection. Copyright © 2014 Elsevier Inc. All rights reserved.
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- "For these treatment - resistant patients , high - frequency electrical stimulation of sub - cortical brain structures , known as deep brain stimulation ( DBS ) , presents a highly successful therapeutic alternative ( Benabid et al . , 2005 ; Williams and Okun , 2013 ) . DBS is FDA - approved for the treatment of Parkinson ' s disease ( PD ) and essential tremor ( ET ) ( Benabid et al . "
ABSTRACT: Current strategies for optimizing deep brain stimulation (DBS) therapy involve multiple postoperative visits. During each visit, stimulation parameters are adjusted until desired therapeutic effects are achieved and adverse effects are minimized. However, the efficacy of these therapeutic parameters may decline with time due at least in part to disease progression, interactions between the host environment and the electrode, and lead migration. As such, development of closed-loop control systems that can respond to changing neurochemical environments, tailoring DBS therapy to individual patients, is paramount for improving the therapeutic efficacy of DBS. Evidence obtained using electrophysiology and imaging techniques in both animals and humans suggests that DBS works by modulating neural network activity. Recently, animal studies have shown that stimulation-evoked changes in neurotransmitter release that mirror normal physiology are associated with the therapeutic benefits of DBS. Therefore, to fully understand the neurophysiology of DBS and optimize its efficacy, it may be necessary to look beyond conventional electrophysiological analyses and characterize the neurochemical effects of therapeutic and non-therapeutic stimulation. By combining electrochemical monitoring and mathematical modeling techniques, we can potentially replace the trial-and-error process used in clinical programming with deterministic approaches that help attain optimal and stable neurochemical profiles. In this manuscript, we summarize the current understanding of electrophysiological and electrochemical processing for control of neuromodulation therapies. Additionally, we describe a proof-of-principle closed-loop controller that characterizes DBS-evoked dopamine changes to adjust stimulation parameters in a rodent model of DBS. The work described herein represents the initial steps toward achieving a "smart" neuroprosthetic system for treatment of neurologic and psychiatric disorders.
- "In another study, direct electrical stimulation (DES) over part of the primary motor cortex that controls hand and wrist movements was used in a randomized clinical trial to facilitate rehabilitation for recovery of upper limb motor function in stroke patients (Harvey and Winstein, 2009). Nevertheless, perhaps the greatest therapeutic efficacy has been observed with deep brain stimulation of subcortical structures in patients with severe neurological disorders (e.g., the subthalamic nucleus in Parkinson's disease; Williams and Okun, 2013). This is puzzling, since the function of the neocortex is better understood than many subcortical structures (cortex is more accessible for neurophysiological and neuroimaging experiments). "
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