Abstract
Neuropsychiatric disorders that are refractory to best medical management continue to pose a significant challenge. Advances in molecular neuroscience and neuroimaging have started to reveal how dysfunction in specific limbic networks mediates these disorders. This knowledge, along with concurrent advances in neurosurgical techniques, has lead to the increasing use of deep brain stimulation (DBS) for the treatment of neuropsychiatric disorders. Here we review the role of DBS for obsessive-compulsive disorder (OCD), depression, addiction, post-traumatic stress disorder (PTSD), and anorexia nervosa (AN). We emphasize the use of translational techniques such as neuroimaging, molecular neuroscience, and animal models in guiding and evaluating the use of DBS for these challenging disorders.
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References
Egas Moniz. How I came to perform prefrontal leucotomy. J Med (Oporto). 1949;14:513–5.
Lapidus KAB, Kopell BH, Ben-Haim S, Rezai AR, Goodman WK. History of psychosurgery: a psychiatrist’s perspective. World Neurosurg. 2013;80:S27.e1–16.
Leiphart JW, Valone FH. Stereotactic lesions for the treatment of psychiatric disorders. J Neurosurg. 2010;113:1204–11.
Lozano AM, Lipsman N. Probing and regulating dysfunctional circuits using deep brain stimulation. Neuron. 2013;77:406–24.
Catani M, Dell'acqua F, Thiebaut de Schotten M. A revised limbic system model for memory, emotion and behaviour. Neurosci Biobehav Rev. 2013;37:1724–37.
Dougherty DD, Rauch SL, Jenike MA. Pharmacotherapy for obsessive-compulsive disorder. J Clin Psychol. 2004;60:1195–202.
Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Mol Psychiatry. 2010;15:53–63.
Robison RA, Taghva A, Liu CY, Apuzzo MLJ. Surgery of the mind, mood, and conscious state: an idea in evolution. World Neurosurg. 2013;80:S2–26.
Knight G. Stereotactic tractotomy in the surgical treatment of mental illness. J Neurol Neurosurg Psychiatr. 1965;28:304–10.
Ballantine HT, Bouckoms AJ, Thomas EK, Giriunas IE. Treatment of psychiatric illness by stereotactic cingulotomy. Biol Psychiatry. 1987;22:807–19.
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;354:1526.
Nuttin BJ, Gabriëls LA, Cosyns PR, Meyerson BA, Andréewitch S, Sunaert SG, et al. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery. 2003;52:1263–72. Discussion 1272–4.
Greenberg BD, Malone DA, Friehs GM, Rezai AR, Kubu CS, Malloy PF, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006;31:2384–93.
Denys D, Mantione M, Figee M, van den Munckhof P, Koerselman F, Westenberg H, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010;67:1061–8.
Hamani C, Pilitsis J, Rughani AI, Rosenow JM, Patil PG, Slavin KS, et al. Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American society for stereotactic and functional neurosurgery and the congress of neurological surgeons (CNS) and endorsed by the CNS and American association of neurological surgeons. Neurosurgery. 2014;75:327–33.
Mallet L, Mesnage V, Houeto J-L, Pelissolo A, Yelnik J, Behar C, et al. Compulsions, Parkinson’s disease, and stimulation. Lancet. 2002;360:1302–4.
Jiménez F, Velasco F, Salín-Pascual R, Velasco M, Nicolini H, Velasco AL, et al. Neuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder. Acta Neurochir Suppl. 2007;97:393–8.
Mallet L, Polosan M, Jaafari N, Baup N, Welter M-L, Fontaine D, et al. Subthalamic nucleus stimulation in severe obsessive-compulsive disorder. N Engl J Med. 2008;359:2121–34.
Mian MK, Campos M, Sheth SA, Eskandar EN. Deep brain stimulation for obsessive-compulsive disorder: past, present, and future. Neurosurg Focus. 2010;29, E10.
Hamani C, Temel Y. Deep brain stimulation for psychiatric disease: contributions and validity of animal models. Sci Transl Med. 2012;4:142rv8.
Tye KM, Deisseroth K. Optogenetic investigation of neural circuits underlying brain disease in animal models. Nat Rev Neurosci. 2012;13:251–66.
Gradinaru V, Mogri M, Thompson KR, Henderson JM, Deisseroth K. Optical deconstruction of parkinsonian neural circuitry. Science. 2009;324:354–9.
Burguière E, Monteiro P, Feng G, Graybiel AM. Optogenetic stimulation of lateral orbitofronto-striatal pathway suppresses compulsive behaviors. Science. 2013;340:1243–6.
Ahmari SE, Spellman T, Douglass NL, Kheirbek MA, Simpson HB, Deisseroth K, et al. Repeated cortico-striatal stimulation generates persistent OCD-like behavior. Science. 2013;340:1234–9.
Henderson JM. “Connectomic surgery”: diffusion tensor imaging (DTI) tractography as a targeting modality for surgical modulation of neural networks. Front Integr Neurosci. 2012;6:15.
Yang JC, Papadimitriou G, Eckbo R, Yeterian EH, Liang L, Dougherty DD, et al. Multi-tensor investigation of orbitofrontal cortex tracts affected in subcaudate tractotomy. Brain Imaging Behav. 2015;9(2):342–52
Pouratian N, Zheng Z, Bari AA, Behnke E, Elias WJ, DeSalles AAF. Multi-institutional evaluation of deep brain stimulation targeting using probabilistic connectivity-based thalamic segmentation. J Neurosurg. 2011;115(5):995–1004.
Barch DM, Burgess GC, Harms MP, Petersen SE, Schlaggar BL, Corbetta M, et al. Function in the human connectome: task-fMRI and individual differences in behavior. Neuroimage. 2013;80:169–89.
Figee M, Luigjes J, Smolders R, Valencia-Alfonso C-E, van Wingen G, de Kwaasteniet B, et al. Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder. Nat Publ Group. 2013;16:386–7.
Lépine J-P, Briley M. The increasing burden of depression. Neuropsychiatr Dis Treat. 2011;7:3–7.
Mayberg HS, Lozano AM, Voon V, McNeely HE, Seminowicz D, Hamani C, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45:651–60.
Schlaepfer TE, Bewernick BH, Kayser S, Hurlemann R, Coenen VA. Deep brain stimulation of the human reward system for major depression—rationale, outcomes and outlook. Neuropsychopharmacology. 2014;39:1303–14.
Schlaepfer TE, Cohen MX, Frick C, Kosel M, Brodesser D, Axmacher N, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology. 2008;33:368–77.
Jiménez F, Velasco F, Salin-Pascual R, Hernández JA, Velasco M, Criales JL, et al. A patient with a resistant major depression disorder treated with deep brain stimulation in the inferior thalamic peduncle. Neurosurgery. 2005;57:585–93. Discussion 585–93.
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. Biol Psychiatry. 2009;65:267–75.
Sartorius A, Henn FA. Deep brain stimulation of the lateral habenula in treatment resistant major depression. Med Hypotheses. 2007;69:1305–8.
Hamani C, Mayberg H, Stone S, Laxton A, Haber S, Lozano AM. The subcallosal cingulate gyrus in the context of major depression. Biol Psychiatry. 2011;69:301–8.
Mayberg HS, Brannan SK, Tekell JL, Silva JA, Mahurin RK, McGinnis S, et al. Regional metabolic effects of fluoxetine in major depression: serial changes and relationship to clinical response. Biol Psychiatry. 2000;48:830–43.
Damasio AR, Grabowski TJ, Bechara A, Damasio H, Ponto LL, Parvizi J, et al. Subcortical and cortical brain activity during the feeling of self-generated emotions. Nat Neurosci. 2000;3:1049–56.
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. Am J Psychiatry. 2011;168:502–10.
Morishita T, Fayad SM, Higuchi M-A, Nestor KA, Foote KD. Deep brain stimulation for treatment-resistant depression: systematic review of clinical outcomes. Neurotherapeutics. 2014;11:475–84.
Coenen VA, Schlaepfer TE, Allert N, Mdler B. Diffusion tensor imaging and neuromodulation: DTI as key technology for deep brain stimulation. Int Rev Neurobiol. 2012;107:207–34 (1st edn. Elsevier Inc.).
Riva-Posse P, Choi KS, Holtzheimer PE, McIntyre CC, Gross RE, Chaturvedi A, et al. Defining critical white matter pathways mediating successful subcallosal cingulate deep brain stimulation for treatment-resistant depression. Biol Psychiatry. 2014;76(12):963–9.
Rea E, Rummel J, Schmidt TT, Hadar R, Heinz A, Mathé AA, et al. Anti-anhedonic effect of deep brain stimulation of the prefrontal cortex and the dopaminergic reward system in a genetic rat model of depression: an intracranial self-stimulation paradigm study. Brain Stimul. 2014;7:21–8.
Hamani C, Amorim BO, Wheeler AL, Diwan M, Driesslein K, Covolan L, et al. Deep brain stimulation in rats: different targets induce similar antidepressant-like effects but influence different circuits. Neurobiol Dis. 2014;71C:205–14.
Vassoler FM, White SL, Hopkins TJ, Guercio LA, Espallergues J, Berton O, et al. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine reinstatement through local and antidromic activation. J Neurosci. 2013;33:14446–54.
Müller UJ, Voges J, Steiner J, Galazky I, Heinze H-J, Möller M, et al. Deep brain stimulation of the nucleus accumbens for the treatment of addiction. Ann N Y Acad Sci. 2013;1282:119–28.
Gao G, Wang X, He S, Li W, Wang Q, Liang Q, et al. Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Stereotact Funct Neurosurg. 2003;81:96–9104.
Ge S, Chang C, Adler JR, Zhao H, Chang X, Gao L, et al. Long-term changes in the personality and psychopathological profile of opiate addicts after nucleus accumbens ablative surgery are associated with treatment outcome. Stereotact Funct Neurosurg. 2013;91:30–44.
Li N, Wang J, Wang X-L, Chang C-W, Ge S-N, Gao L, et al. Nucleus accumbens surgery for addiction. World Neurosurg. 2013;80(3–4):S28.e9–19.
Kuhn J, Lenartz D, Huff W, Lee S, Koulousakis A, Klosterkoetter J, et al. Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: valuable therapeutic implications? J Neurol Neurosurg Psychiatry. 2007;78:1152–3.
Kuhn J, Bauer R, Pohl S, Lenartz D, Huff W, Kim EH, et al. Observations on unaided smoking cessation after deep brain stimulation of the nucleus accumbens. Eur Addict Res. 2009;15:196–201.
Mantione M, van de Brink W, Schuurman PR, Denys D. Smoking cessation and weight loss after chronic deep brain stimulation of the nucleus accumbens: therapeutic and research implications: case report. Neurosurgery. 2010;66, E218. Discussion E218.
Muller UJ, Sturm V, Voges J, Heinze H-J, Galazky I, Heldmann M, et al. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. Pharmacopsychiatry. 2009;42:288–91.
Voges J, Müller U, Bogerts B, Münte T, Heinze H-J. Deep brain stimulation surgery for alcohol addiction. World Neurosurg. 2013;80:S28.e21–31.
Kuhn J, Gründler TOJ, Bauer R, Huff W, Fischer AG, Lenartz D, et al. Successful deep brain stimulation of the nucleus accumbens in severe alcohol dependence is associated with changed performance monitoring. Addict Biol. 2011;16:620–3.
Kuhn J, Möller M, Treppmann JF, Bartsch C, Lenartz D, Gruendler TOJ, et al. Deep brain stimulation of the nucleus accumbens and its usefulness in severe opioid addiction. Mol Psychiatry. 2014;19:145–6.
Zhou H, Xu J, Jiang J. Deep brain stimulation of nucleus accumbens on heroin-seeking behaviors: a case report. Biol Psychiatry. 2011;69:e41–2.
Valencia-Alfonso C-E, Luigjes J, Smolders R, Cohen MX, Levar N, Mazaheri A, et al. Effective deep brain stimulation in heroin addiction: a case report with complementary intracranial electroencephalogram. Biol Psychiatry. 2012;71:e35–7.
Stuber GD. Dissecting the neural circuitry of addiction and psychiatric disease with optogenetics. Neuropsychopharmacology. 2010;35:341–2.
Britt JP, Bonci A. Optogenetic interrogations of the neural circuits underlying addiction. Curr Opin Neurobiol. 2013;23:539–45.
Van Essen DC, Smith SM, Barch DM, Behrens TEJ, Yacoub E, Ugurbil K, et al. The WU-Minn human connectome project: an overview. Neuroimage. 2013;80:62–79.
Breslau N. Outcomes of posttraumatic stress disorder. J Clin Psychiatry. 2001;62:55–9. Suppl 17.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:593–602.
Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005;62:617–27.
Armony JL, Corbo V, Clément M-H, Brunet A. Amygdala response in patients with acute PTSD to masked and unmasked emotional facial expressions. Am J Psychiatry. 2005;162:1961–3.
Protopopescu X, Pan H, Tuescher O, Cloitre M, Goldstein M, Engelien W, et al. Differential time courses and specificity of amygdala activity in posttraumatic stress disorder subjects and normal control subjects. Biol Psychiatry. 2005;57:464–73.
Shin LM, Orr SP, Carson MA, Rauch SL, Macklin ML, Lasko NB, et al. Regional cerebral blood flow in the amygdala and medial prefrontal cortex during traumatic imagery in male and female Vietnam veterans with PTSD. Arch Gen Psychiatry. 2004;61:168–76.
Koenigs M, Huey ED, Raymont V, Cheon B, Solomon J, Wassermann EM, et al. Focal brain damage protects against post-traumatic stress disorder in combat veterans. Nat Neurosci. 2008;11:232–7.
Koenigs M, Grafman J. Posttraumatic stress disorder: the role of medial prefrontal cortex and amygdala. Neuroscientist. 2009;15:540–8.
Langevin J-P, De Salles AAF, Kosoyan HP, Krahl SE. Deep brain stimulation of the amygdala alleviates post-traumatic stress disorder symptoms in a rat model. J Psychiatr Res. 2010;44:1241–5.
Stidd DA, Vogelsang K, Krahl SE, Langevin J-P, Fellous J-M. Amygdala deep brain stimulation is superior to paroxetine treatment in a rat model of posttraumatic stress disorder. Brain Stimul. 2013;6(6):837–44.
Yan X, Brown AD, Lazar M, Cressman VL, Henn-Haase C, Neylan TC, et al. Spontaneous brain activity in combat related PTSD. Neurosci Lett. 2013;547:1–5.
Brown VM, LaBar KS, Haswell CC, Gold AL, Mid-Atlantic MIRECC Workgroup, McCarthy G, et al. Altered resting-state functional connectivity of basolateral and centromedial amygdala complexes in posttraumatic stress disorder. Neuropsychopharmacology. 2014;39:351–9.
Rabinak CA, Angstadt M, Welsh RC, Kenndy AE, Lyubkin M, Martis B, et al. Altered amygdala resting-state functional connectivity in post-traumatic stress disorder. Front Psychiatry. 2011;2:62.
Sripada RK, King AP, Garfinkel SN, Wang X, Sripada CS, Welsh RC, et al. Altered resting-state amygdala functional connectivity in men with posttraumatic stress disorder. J Psychiatry Neurosci. 2012;37:241–9.
Koek RJ, Langevin J-P, Krahl SE, Kosoyan HJ, Schwartz HN, Chen JW, et al. Deep brain stimulation of the basolateral amygdala for treatment-refractory combat post-traumatic stress disorder (PTSD): study protocol for a pilot randomized controlled trial with blinded, staggered onset of stimulation. Trials. 2014;15:356.
Sturm V, Fricke O, Bührle CP, Lenartz D, Maarouf M, Treuer H, et al. DBS in the basolateral amygdala improves symptoms of autism and related self-injurious behavior: a case report and hypothesis on the pathogenesis of the disorder. Front Hum Neurosci. 2012;6:341.
Kent AR, Grill WM. Analysis of deep brain stimulation electrode characteristics for neural recording. J Neural Eng. 2014;11:046010.
Hosain MK, Kouzani A, Tye S. Closed loop deep brain stimulation: an evolving technology. Australas Phys Eng Sci Med. 2014;37(4):619–34.
Papadopoulos FC, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry. 2009;194:10–7.
Drury MO. An emergency leucotomy. Br Med J. 1950;2:609.
Lipsman N, Woodside DB, Giacobbe P, Lozano AM. Neurosurgical treatment of anorexia nervosa: review of the literature from leucotomy to deep brain stimulation. Eur Eat Disord Rev. 2013;21:428–35.
Barbier J, Gabriëls L, Van Laere K, Nuttin B. Successful anterior capsulotomy in comorbid anorexia nervosa and obsessive-compulsive disorder: case report. Neurosurgery. 2011;69:E745–51. Discussion E751.
Laćan G, De Salles AAF, Gorgulho AA, Krahl SE, Frighetto L, Behnke EJ, et al. Modulation of food intake following deep brain stimulation of the ventromedial hypothalamus in the vervet monkey. Laboratory investigation. J Neurosurg. 2008;108:336–42.
van der Plasse G, Schrama R, van Seters SP, Vanderschuren LJMJ, Westenberg HGM. Deep brain stimulation reveals a dissociation of consummatory and motivated behaviour in the medial and lateral nucleus accumbens shell of the rat. PLoS One. 2012;7, e33455.
Welkenhuysen M, van Kuyck K, Das J, Sciot R, Nuttin B. Electrical stimulation in the lateral hypothalamus in rats in the activity-based anorexia model. Neurosurg Focus. 2008;25, E7.
Israël M, Steiger H, Kolivakis T, McGregor L, Sadikot AF. Deep brain stimulation in the subgenual cingulate cortex for an intractable eating disorder. Biol Psychiatry. 2010;67:e53–4.
McLaughlin NCR, Didie ER, Machado AG, Haber SN, Eskandar EN, Greenberg BD. Improvements in anorexia symptoms after deep brain stimulation for intractable obsessive-compulsive disorder. Biol Psychiatry. 2013;73:e29–31.
Lipsman N, Woodside DB, Giacobbe P, Hamani C, Carter JC, Norwood SJ, et al. Subcallosal cingulate deep brain stimulation for treatment-refractory anorexia nervosa: a phase 1 pilot trial. Lancet. 2013;381:1361–70.
Kringelbach ML, Green AL, Aziz TZ. Balancing the brain: resting state networks and deep brain stimulation. Front Integr Neurosci. 2011;5:8.
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Bari, A.A., King, N.K.K., Lipsman, N., Lozano, A.M. (2016). Deep Brain Stimulation for Neuropsychiatric Disorders. In: Tuszynski, M. (eds) Translational Neuroscience. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7654-3_26
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