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Chapter 13 - Managing Patients with Psychiatric Conditions Treated with Deep Brain Stimulation

Published online by Cambridge University Press:  09 June 2022

William J. Marks
Stanford University, California
Jill L. Ostrem
University of California, San Francisco
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Psychiatric disorders, including depression, obsessive-compulsive disorder (OCD), addictions, and even schizophrenia, are the newest frontier for deep brain stimulation (DBS). The evidence base for specific anatomic targets and disease indications remains fluid, as few centers have the technical expertise and cross-disciplinary integration required to explore the boundaries of clinical knowledge. As such, most psychiatric DBS remains experimental.

Publisher: Cambridge University Press
Print publication year: 2022

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Widge, AS, Malone, DAJ, Dougherty, DD. Closing the loop on deep brain stimulation for treatment-resistant depression. Front Neurosci. 2018;12:175.CrossRefGoogle ScholarPubMed
Park, LT, Dougherty, DD, Rauch, SL. Neurosurgical treatments for psychiatric indications. In Jeste, DV, Friedman, JH, editors. Psychiatry for Neurologists [Internet]. Humana Press; 2006 [cited 2014 Mar 27]. pp. 339361. (Current Clinical Neurology). Available from: Scholar
Knight, G. Stereotactic tractotomy in the surgical treatment of mental illness. J Neurol Neurosurg Psychiatry. 1965 Aug;28(4):304310.CrossRefGoogle ScholarPubMed
Brown, LT, Mikell, CB, Youngerman, BE, Zhang, Y, McKhann, GM, Sheth, SA. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive-compulsive disorder: A systematic review of observational studies. Journal of Neurosurgery. 2016 Jan 1;124(1):7789.CrossRefGoogle ScholarPubMed
Rasmussen, SA, Noren, G, Greenberg, BD, Marsland, R, McLaughlin, NC, Malloy, PJ, et al. Gamma ventral capsulotomy in intractable obsessive-compulsive disorder. Biological Psychiatry. 2018 Sep 1;84(5):355364.CrossRefGoogle ScholarPubMed
Ballantine, HT Jr., Bouckoms, AJ, Thomas, EK, Giriunas, IE. Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry. 1987 Jul;22(7):807819.CrossRefGoogle ScholarPubMed
Sheth, SA, Neal, J, Tangherlini, F, Mian, MK, Gentil, A, Cosgrove, GR, et al. Limbic system surgery for treatment-refractory obsessive-compulsive disorder: A prospective long-term follow-up of 64 patients. Journal of Neurosurgery. 2012 Dec 14;118(3):491497.CrossRefGoogle ScholarPubMed
Kelly, D, Richardson, A, Mitchell-Heggs, N. Stereotactic limbic leucotomy: Neurophysiological aspects and operative technique. Br J Psychiatry. 1973 Aug;123(573):133140.CrossRefGoogle ScholarPubMed
Montoya, A, Weiss, AP, Price, BH, Cassem, EH, Dougherty, DD, Nierenberg, AA, et al. Magnetic resonance imaging-guided stereotactic limbic leukotomy for treatment of intractable psychiatric disease. Neurosurgery. May 2002. 2002;50(5):10431052.Google ScholarPubMed
Dougherty, DD, Brennan, B, Stewart, SE, Wilhelm, S, Widge, AS, Rauch, SL. Neuroscientifically informed formulation and treatment planning for patients with obsessive-compulsive disorder: A review. JAMA Psychiatry. 2018;75(10):10811087.CrossRefGoogle ScholarPubMed
Nuttin, B, Cosyns, P, Demeulemeester, H, Gybels, J, Meyerson, B. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999 Oct 30;354(9189):1526.CrossRefGoogle ScholarPubMed
Abelson, JL, Curtis, GC, Sagher, O, Albucher, RC, Harrigan, M, Taylor, SF, et al. Deep brain stimulation for refractory obsessive-compulsive disorder. Biological Psychiatry. 2005 Mar 1;57(5):510516.CrossRefGoogle ScholarPubMed
Karas, PJ, Lee, S, Jimenez-Shahed, J, Goodman, WK, Viswanathan, A, Sheth, SA. Deep brain stimulation for obsessive compulsive disorder: Evolution of surgical stimulation target parallels changing model of dysfunctional brain circuits. Front Neurosci. 2019;12:998.CrossRefGoogle ScholarPubMed
Luyten, L, Hendrickx, S, Raymaekers, S, Gabriëls, L, Nuttin, B. Electrical stimulation in the bed nucleus of the stria terminalis alleviates severe obsessive-compulsive disorder. Mol Psychiatry. 2016 Sep;21(9):12721280.CrossRefGoogle ScholarPubMed
Menchón, JM, Real, E, Alonso, P, Aparicio, MA, Segalas, C, Plans, G, et al. A prospective international multi-center study on safety and efficacy of deep brain stimulation for resistant obsessive-compulsive disorder. Mol Psychiatry. 2019 Oct;29:114.Google Scholar
Malone, DA, Dougherty, DD, Rezai, AR, Carpenter, LL, Friehs, GM, Eskandar, EN, et al. Deep brain stimulation of the ventral capsule/ventral striatum for treatment-resistant depression. Biological Psychiatry. 2009 Feb 15;65(4):267275.CrossRefGoogle ScholarPubMed
Dougherty, DD, Rezai, AR, Carpenter, LL, Howland, RH, Bhati, MT, O’Reardon, JP, et al. A randomized sham-controlled trial of deep brain stimulation of the ventral capsule/ventral striatum for chronic treatment-resistant depression. Biological Psychiatry. 2015 Aug;78(4):240248.CrossRefGoogle ScholarPubMed
Bergfeld, IO, Mantione, M, Hoogendorn, ML, Ruhé, HG, Notten, P, Van Laarhoven, J, et al. Deep brain stimulation of the ventral anterior limb of the internal capsule for treatment-resistant depression: A randomized clinical trial. JAMA Psychiatry. 2016 Apr 6;73(5):456464.CrossRefGoogle ScholarPubMed
Mayberg, HS, Lozano, AM, Voon, V, McNeely, HE, Seminowicz, D, Hamani, C, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005 Mar;45(5):651660.CrossRefGoogle ScholarPubMed
Kennedy, SH, Giacobbe, P, Rizvi, SJ, Placenza, FM, Nishikawa, Y, Mayberg, HS, et al. Deep brain stimulation for treatment-resistant depression: Follow-up after 3 to 6 years. American Journal of Psychiatry. 2011;168(5):502510.CrossRefGoogle ScholarPubMed
Van Laere, K, Nuttin, B, Gabriels, L, Dupont, P, Rasmussen, S, Greenberg, BD, et al. Metabolic imaging of anterior capsular stimulation in refractory obsessive-compulsive disorder: A key role for the subgenual anterior cingulate and ventral striatum. Journal of Nuclear Medicine. 2006;47(5):740747.Google ScholarPubMed
Holtzheimer, PE, Husain, MM, Lisanby, SH, Taylor, SF, Whitworth, LA, McClintock, S, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant depression: A multisite, randomised, sham-controlled trial. Lancet Psychiatry. 2017 Oct 4;4:839849.CrossRefGoogle ScholarPubMed
Coenen, VA, Bewernick, BH, Kayser, S, Kilian, H, Boström, J, Greschus, S, et al. Superolateral medial forebrain bundle deep brain stimulation in major depression: A gatezway trial. Neuropsychopharmacology. 2019 Jun; 44(7):12241232. doi: 10.1038/s41386-019-0369-9. Epub 2019 Mar 13.CrossRefGoogle ScholarPubMed
Garnaat, SL, Greenberg, BD, Sibrava, NJ, Goodman, WK, Mancebo, MC, Eisen, JL, et al. Who qualifies for deep brain stimulation for OCD? Data from a naturalistic clinical sample. J Neuropsychiatry Clin Neurosci. 2014 Jan 1;26(1):8186.CrossRefGoogle ScholarPubMed
Goodman, WK, Price, L, Rasmussen, SA, Mazure, C, Fleischmann, R, Hill, C, et al. The Yale-Brown Obsessive Compulsive Scale: I. development, use, and reliability. Arch Gen Psychiatry. 1989 Nov 1;46(11):10061011.CrossRefGoogle ScholarPubMed
Carmi, L, Tendler, A, Bystritsky, A, Hollander, E, Blumberger, DM, Daskalakis, J, et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. AJP. 2019 May 21;appi.ajp.2019.1.CrossRefGoogle Scholar
Grisso, T, Appelbaum, PS. Macarthur Competence Assessment Tool for Treatment. 1 edition. Sarasota, FL: Professional Resource Exchange; 1998.Google Scholar
Williams, NR, Short, EB, Sahlem, G, Kerns, S, Williams, E, Hanlon, CA, et al. Deep brain stimulation to the reward circuitry exerts antidepressant effects on treatment-resistant depression in a patient with Parkinson’s disease. Biological Psychiatry. 2014;75(9):260S.Google Scholar
Tyagi, H, Apergis-Schoute, AM, Akram, H, Foltynie, T, Limousin, P, Drummond, LM, et al. A randomised trial directly comparing ventral capsule and anteromedial subthalamic nucleus stimulation in obsessive compulsive disorder: Clinical and imaging evidence for dissociable effects. Biological Psychiatry. 2019 Jan 30;85(9):726734.CrossRefGoogle Scholar
Widge, AS, Zorowitz, S, Basu, I, Paulk, AC, Cash, SS, Eskandar, EN, et al. Deep brain stimulation of the internal capsule enhances human cognitive control and prefrontal cortex function. Nature Communications. 2019;10:1536.CrossRefGoogle ScholarPubMed
Haq, IU, Foote, KD, Goodman, WG, Wu, SS, Sudhyadhom, A, Ricciuti, N, et al. Smile and laughter induction and intraoperative predictors of response to deep brain stimulation for obsessive-compulsive disorder. NeuroImage. 2011 Jan;54, Supplement 1(0):S247S255.CrossRefGoogle Scholar
Schruers, K, Baldi, S, Heuvel T van, den, Goossens, L, Luyten, L, Leentjens, AFG, et al. The effects of deep-brain non-stimulation in severe obsessive-compulsive disorder: An individual patient data meta-analysis. Transl Psychiatry. 2019 Aug 5;9(1):18.CrossRefGoogle ScholarPubMed
Haber, SN, Heilbronner, SR. Translational research in OCD: Circuitry and mechanisms. Neuropsychopharmacology. 2013 Jan;38(1):252253.CrossRefGoogle ScholarPubMed
Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. BJP. 1979 Apr 1;134(4):382389.CrossRefGoogle ScholarPubMed
Kroenke, K, Spitzer, RL, Williams, JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606613.CrossRefGoogle ScholarPubMed
Rush, AJ, Trivedi, MH, Ibrahim, HM, Carmody, TJ, Arnow, B, Klein, DN, et al. The 16-Item quick inventory of depressive symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): A psychometric evaluation in patients with chronic major depression. Biological Psychiatry. 2003 Sep 1;54(5):573583.CrossRefGoogle ScholarPubMed
Abramowitz, JS, Deacon, BJ, Olatunji, BO, Wheaton, MG, Berman, NC, Losardo, D, et al. Assessment of obsessive-compulsive symptom dimensions: Development and evaluation of the Dimensional Obsessive-Compulsive Scale. Psychological Assessment. 2010;22(1):180198.CrossRefGoogle ScholarPubMed
Foa, EB, Huppert, JD, Leiberg, S, Langner, R, Kichic, R, Hajcak, G, et al. The Obsessive-Compulsive Inventory: Development and validation of a short version. Psychological Assessment. 2002;14(4):485496.CrossRefGoogle ScholarPubMed
Widge, AS, Licon, E, Zorowitz, S, Corse, A, Arulpragasam, AR, Camprodon, JA, et al. Predictors of hypomania during ventral capsule/ventral striatum deep brain stimulation. Journal of Neuropsychiatry and Clinical Neurosciences. 2015;28(1):3844.CrossRefGoogle ScholarPubMed
Holtzheimer, PE, Kelley, ME, Gross, RE, Filkowski, MM, Garlow, SJ, Barrocas, A, et al. Subcallosal cingulate deep brain stimulation for treatment-resistant unipolar and bipolar depression. Archives of General Psychiatry. 2012 Jan 2;69(2):150158.CrossRefGoogle ScholarPubMed
Raymaekers, S, Vansteelandt, K, Luyten, L, Bervoets, C, Demyttenaere, K, Gabriëls, L, et al. Long-term electrical stimulation of bed nucleus of stria terminalis for obsessive-compulsive disorder. Mol Psychiatry. 2017 Jun;22(6):931934.CrossRefGoogle ScholarPubMed
Rodriguez-Romaguera, J, Greenberg, BD, Haber, SN, Quirk, GJ. A cross species approach to understanding DBS modulation of fear. Brain Stimulation. 2015;8(5):986988.CrossRefGoogle Scholar
Mantione, M, Nieman, DH, Figee, M, Denys, D. Cognitive-behavioural therapy augments the effects of deep brain stimulation in obsessive-compulsive disorder. Psychological Medicine. 2014 Dec;44(16):35153522.CrossRefGoogle ScholarPubMed
Riva-Posse, P, Choi, KS, Holtzheimer, PE, Crowell, AL, Garlow, SJ, Rajendra, JK, et al. A connectomic approach for subcallosal cingulate deep brain stimulation surgery: Prospective targeting in treatment-resistant depression. Molecular Psychiatry. 2018;23:843849.CrossRefGoogle ScholarPubMed
Ramasubbu, R, Clark, DL, Golding, S, Dobson, KS, Mackie, A, Haffenden, A, et al. Long versus short pulse width subcallosal cingulate stimulation for treatment-resistant depression: A randomised, double-blind, crossover trial. Lancet Psychiatry. 2020 Jan 1;7(1):2940.CrossRefGoogle ScholarPubMed
Noecker, AM, Choi, KS, Riva-Posse, P, Gross, RE, Mayberg, HS, McIntyre, CC. StimVision software: Examples and applications in subcallosal cingulate deep brain stimulation for depression. Neuromodulation: Technology at the Neural Interface. 2018;21(2):191196.CrossRefGoogle Scholar
Velisar, A, Syrkin-Nikolau, J, Blumenfeld, Z, Trager, MH, Afzal, MF, Prabhakar, V, et al. Dual threshold neural closed loop deep brain stimulation in Parkinson disease patients. Brain Stimulation. 2019;12(4):868876.CrossRefGoogle ScholarPubMed
Bilge, MT, Kanabar, A, Boggess, MJ, Rockhill, AP, Gosai, AK, Hahn, E, et al. Treating psychiatric illness through targeted network disruption and electrical biomarker identification. 2019 BRAIN Initiative PI Meeting; 2019 Apr; Washington, DC.Google Scholar
Widge, AS, Ellard, KK, Paulk, AC, Basu, I, Yousefi, A, Zorowitz, S, et al. Treating refractory mental illness with closed-loop brain stimulation: Progress towards a patient-specific transdiagnostic approach. Experimental Neurology. 2017;287(4):361472.CrossRefGoogle ScholarPubMed
Widge, AS, Miller, EK. Next-generation clinical brain stimulation: Targeting cognition and networks through neural oscillations. JAMA Psychiatry. 2019;76(7):671672.CrossRefGoogle ScholarPubMed
Provenza, NR, Paulk, AC, Peled, N, Restrepo, MI, Cash, SS, Dougherty, DD, et al. Decoding task engagement from distributed network electrophysiology in humans. Journal of Neural Engineering. 2019;16:056015.CrossRefGoogle ScholarPubMed
Greenberg, BD, Rauch, SL, Haber, SN. Invasive circuitry-based neurotherapeutics: Stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology. 2010;35(1):317336.CrossRefGoogle ScholarPubMed
Mayberg, HS. Targeted electrode-based modulation of neural circuits for depression. J Clin Invest. 2009 Apr;119(4):717725.CrossRefGoogle ScholarPubMed
Dougherty, DD, Brennan, BP, Stewart, SE, Wilhelm, S, Widge, AS, Rauch, SL. Neuroscientifically informed formulation and treatment planning for patients with obsessive-compulsive disorder: A review. JAMA Psychiatry. 2018;75(10):10811087. doi:10.1001/jamapsychiatry.2018.0930CrossRefGoogle ScholarPubMed
Malone, DA, Dougherty, DD, Rezai, AR, et al. Deep brain stimulation of the ventral capsule/ventral striatum for Streatment-resistant depression. Biol Psychiatry. 2009;65(4):267275.CrossRefGoogle ScholarPubMed
Haber, S, Heilbronner, S. Translational research in OCD: Circuitry and mechanisms. Neuropsychopharmacology 2013;38, 252253. ScholarPubMed

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