Deep Brain Stimulation for Psychiatric Disorders

Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94143-0112, USA.
Neurotherapeutics (Impact Factor: 5.05). 02/2008; 5(1):50-8. DOI: 10.1016/j.nurt.2007.11.006
Source: PubMed


Surgery for psychiatric disorders first began in the early part of the last century when the therapeutic options for these patients were limited. The introduction of deep brain stimulation (DBS) has caused a new interest in the surgical treatment of these disorders. DBS may have some advantage over lesioning procedures used in the past. A critical review of the major DBS targets under investigation for Tourette's syndrome, obsessive-compulsive disorder, and major depression is presented. Current and future challenges for the use of DBS in psychiatric disorders are discussed, as well as a rationale for referring to this subspecialty as limbic disorders surgery based on the parallels with movement disorders surgery.

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    • "It is widely accepted that brain function can be modulated by electrical stimulation of focal brain structures; furthermore, that electrical stimulation may possibly be used to treat patients with brain dysfunction. In particular, deep brain stimulation (DBS) has been used to treat various types of movement disorders and psychiatric disorders [1–3]. Recently, DBS of memory-associated brain structures were tested as a possible treatment for Alzheimer's-type dementia, with some studies providing promising results. "
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    ABSTRACT: Deep brain stimulation (DBS) has been found to have therapeutic effects in patients with dementia, but DBS mechanisms remain elusive. To provide evidence for the effectiveness of DBS as a treatment for dementia, we performed DBS in a rat model of dementia with intracerebroventricular administration of 192 IgG-saporins. We utilized four groups of rats, group 1, unlesioned control; group 2, cholinergic lesion; group 3, cholinergic lesion plus medial septum (MS) electrode implantation (sham stimulation); group 4, cholinergic lesions plus MS electrode implantation and stimulation. During the probe test in the water maze, performance of the lesion group decreased for measures of time spent and the number of swim crossings over the previous platform location. Interestingly, the stimulation group showed an equivalent performance to the normal group on all measures. And these are partially reversed by the electrode implantation. Acetylcholinesterase activity in the hippocampus was decreased in lesion and implantation groups, whereas activity in the stimulation group was not different from the normal group. Hippocampal neurogenesis was increased in the stimulation group. Our results revealed that DBS of MS restores spatial memory after damage to cholinergic neurons. This effect is associated with an increase in hippocampal cholinergic activity and neurogenesis.
    Full-text · Article · Jul 2014 · BioMed Research International
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    • "Patients with various neurological disorders could benefit from the stereotaxic implant of chronic intracerebral microelectrodes to record endogenous activity and/or to electrically stimulate specific brain areas (Donoghue et al., 2007; Larson, 2008; Truccolo et al., 2008; Velliste et al., 2008; Benabid et al., 2009; Normann et al., 2009; Hemm and Wårdell, 2010). To be functional and safe, the implant should keep a stable electric interface with the tissue , enabling an efficient recording and/or activation of neurons over time. "
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    ABSTRACT: The use of implants that allow chronic electrical stimulation and recording in the brain of human patients is currently limited by a series of events that cause the deterioration over time of both the electrode surface and the surrounding tissue. The main reason of failure is the tissue inflammatory reaction that eventually causes neuronal loss and glial encapsulation, resulting in a progressive increase of the electrode-electrolyte impedance. Here, we describe a new method to create bio-inspired electrodes to mimic the mechanical properties and biological composition of the host tissue. This combination has a great potential to increase the implant lifetime by reducing tissue reaction and improving electrical coupling. Our method implies coating the electrode with reprogrammed neural or glial cells encapsulated within a hydrogel layer. We chose fibrin as a hydrogel and primary hippocampal neurons or astrocytes from rat brain as cellular layer. We demonstrate that fibrin coating is highly biocompatible, forms uniform coatings of controllable thickness, does not alter the electrochemical properties of the microelectrode and allows good quality recordings. Moreover, it reduces the amount of host reactive astrocytes - over time - compared to a bare wire and is fully reabsorbed by the surrounding tissue within 7 days after implantation, avoiding the common problem of hydrogels swelling. Both astrocytes and neurons could be successfully grown onto the electrode surface within the fibrin hydrogel without altering the electrochemical properties of the microelectrode. This bio-hybrid device has therefore a good potential to improve the electrical integration at the neuron-electrode interface and support the long-term success of neural prostheses.
    Full-text · Article · Apr 2014 · Frontiers in Neuroengineering
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    • "Neuro-modulatory and neuro-prosthetic devices are increasingly developed for a number of neurological and psychiatric disorders in various targets of the central nervous system (Berney and Vingerhoets, 2005; Rasche et al., 2006; Larson, 2008; Benabid et al., 2009). One of the most prominent examples can be found in the field of deep brain stimulation (DBS) to treat psychomotor disorders like Parkinson's disease (PD) affecting 1% of the population in the age group above 60 (Benabid et al., 2000a,b; Jankovic and Aguilar, 2008; Hemm and Wardell, 2010). "
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    ABSTRACT: Minimizing the foreign body response is seen as one critical research strategy for implants especially when designed for immune-privileged organs like the brain. The context of this work is to improve deep brain stimulating devices used in a consistently growing spectrum of psychomotor and psychiatric diseases mainly in form of stiff electrodes. Based on the compliance match hypothesis of biocompatibility we present another step forward using flexible implant materials covered with brain cell-mimicking layers. We covered two types of flexible polyimide films with glandular stem cells derived from pancreatic acini. Using real time-PCR and fluorescent immunocytochemistry we analyzed markers representing various cell types of all three germ layers and stemness. The results demonstrate an unchanged differentiation potential of the polyimide fixated cells as measured by mRNA and protein level. Additionally we developed a fibrinous hydrogel coating to protect them against shear forces upon eventual implantation. By repeating previous analysis and additional metabolism tests for all stages we corroborate the validity of this improvement. Consequently we assume that a stem cell-containing cover may provide a native, fully and actively integrating brain-mimicking interface to the neuropil.
    Full-text · Article · Oct 2011 · Frontiers in Neuroscience
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