Invasive Brain Stimulation in the Treatment of Psychiatric Illness–Proposed Indications and Approaches.
Journal
Deutsches Arzteblatt international
ISSN: 1866-0452
Titre abrégé: Dtsch Arztebl Int
Pays: Germany
ID NLM: 101475967
Informations de publication
Date de publication:
22 01 2021
22 01 2021
Historique:
received:
02
04
2019
revised:
02
04
2019
accepted:
14
09
2020
entrez:
24
3
2021
pubmed:
25
3
2021
medline:
7
4
2021
Statut:
ppublish
Résumé
Drugs, psychotherapy, and other treatment modalities are effective for many patients with mental illness. Nonetheless, many patients do not achieve a total remission with the currently available interventions, and the recurrence rates are high. As part of the ongoing search for further treatment options for refractory disorders, there is renewed interest in focal neuromodulatory techniques, including invasive ones, and deep brain stimulation (DBS) in particular. In this review article, a group consisting of neurosurgeons, psychiatrists, and one practicing ethicist/neurologist summarizes the main aspects of the use of DBS to treat mental illness and offers recommendations on its indications and practical implementation. The efficacy of DBS against mental illness has not been confirmed in the randomized, controlled trials (RCTs) that have been published to date. This may be because the follow-up times were too short. In contrast to the negative RCTs, case series have indeed shown a positive effect of DBS on severe depression, but this effect can only be seen several months after the operation. DBS may be a therapeutic option for selected patients with otherwise intractable mental illness. Patients should only be treated in the setting of clinical trials. RCTs with longer follow-up times must be conducted in order to substantiate, if possible, the promising evidence that has been found in case series.
Sections du résumé
BACKGROUND
Drugs, psychotherapy, and other treatment modalities are effective for many patients with mental illness. Nonetheless, many patients do not achieve a total remission with the currently available interventions, and the recurrence rates are high. As part of the ongoing search for further treatment options for refractory disorders, there is renewed interest in focal neuromodulatory techniques, including invasive ones, and deep brain stimulation (DBS) in particular.
METHODS
In this review article, a group consisting of neurosurgeons, psychiatrists, and one practicing ethicist/neurologist summarizes the main aspects of the use of DBS to treat mental illness and offers recommendations on its indications and practical implementation.
RESULTS
The efficacy of DBS against mental illness has not been confirmed in the randomized, controlled trials (RCTs) that have been published to date. This may be because the follow-up times were too short. In contrast to the negative RCTs, case series have indeed shown a positive effect of DBS on severe depression, but this effect can only be seen several months after the operation.
CONCLUSION
DBS may be a therapeutic option for selected patients with otherwise intractable mental illness. Patients should only be treated in the setting of clinical trials. RCTs with longer follow-up times must be conducted in order to substantiate, if possible, the promising evidence that has been found in case series.
Identifiants
pubmed: 33759753
pii: arztebl.m2021.0017
doi: 10.3238/arztebl.m2021.0017
pmc: PMC8129059
doi:
pii:
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
31-36Références
Dtsch Arztebl Int. 2015 Aug 3;112(31-32):519-26
pubmed: 26334979
J Psychiatry Neurosci. 2013 Sep;38(5):325-32
pubmed: 23527884
Nature. 2008 Oct 16;455(7215):894-902
pubmed: 18923511
Brain Stimul. 2017 May - Jun;10(3):664-671
pubmed: 28259544
J Affect Disord. 2016 Apr;194:33-7
pubmed: 26802505
Br Med Bull. 2003;65:193-207
pubmed: 12697626
Biotechnol J. 2008 Dec;3(12):1511-20
pubmed: 19072907
Mol Psychiatry. 2018 Apr;23(4):843-849
pubmed: 28397839
Arch Gen Psychiatry. 2012 Feb;69(2):150-8
pubmed: 22213770
Biol Psychiatry. 2009 Feb 15;65(4):267-75
pubmed: 18842257
Transl Psychiatry. 2018 Jun 4;8(1):111
pubmed: 29867109
Mol Psychiatry. 2016 Sep;21(9):1272-80
pubmed: 26303665
Neuropsychopharmacology. 2008 Jan;33(2):368-77
pubmed: 17429407
Transl Psychiatry. 2017 Oct 31;7(10):e1251
pubmed: 29087373
J Clin Psychiatry. 1997;58 Suppl 13:23-9
pubmed: 9402916
J Affect Disord. 2016 Oct;203:143-151
pubmed: 27288959
Lancet Psychiatry. 2017 Nov;4(11):839-849
pubmed: 28988904
Biol Psychiatry. 2015 Aug 15;78(4):240-8
pubmed: 25726497
Exp Neurol. 2013 Nov;249:160-8
pubmed: 24012926
J Neurosurg. 2012 Feb;116(2):315-22
pubmed: 22098195
J Affect Disord. 2018 Feb;227:521-529
pubmed: 29161674
Brain Stimul. 2011 Jan;4(1):7-16
pubmed: 21255750
Behav Brain Res. 2019 Feb 1;359:266-273
pubmed: 30414974
Neuron. 2005 Mar 3;45(5):651-60
pubmed: 15748841
Arch Gen Psychiatry. 2010 Oct;67(10):1061-8
pubmed: 20921122
JAMA Psychiatry. 2018 Apr 1;75(4):336-346
pubmed: 29450462
Biol Psychiatry. 2013 Jun 15;73(12):1204-12
pubmed: 23562618
Biol Psychiatry. 2010 Jan 15;67(2):110-6
pubmed: 19914605
Brain Stimul. 2012 Oct;5(4):653-5
pubmed: 22100456
J Psychiatr Res. 2018 Jan;96:124-134
pubmed: 29032294
Depress Anxiety. 2018 May;35(5):468-480
pubmed: 29697875
Cleve Clin J Med. 2010 Jul;77 Suppl 3:S77-80
pubmed: 20622083
JAMA Psychiatry. 2016 May 1;73(5):456-64
pubmed: 27049915
Am J Psychiatry. 2006 Nov;163(11):1905-17
pubmed: 17074942
Biol Psychiatry. 2015 Aug 15;78(4):218-9
pubmed: 26195174
Mol Psychiatry. 2014 May;19(5):607-14
pubmed: 23711979
Mol Psychiatry. 2018 May;23(5):1094-1112
pubmed: 29483673
Psychopharmacol Bull. 1992;28(3):261-74
pubmed: 1480730
Int J Neuropsychopharmacol. 2012 Feb;15(1):121-33
pubmed: 21777510
Neuropsychopharmacology. 2019 Jun;44(7):1224-1232
pubmed: 30867553
Am J Psychiatry. 2011 May;168(5):502-10
pubmed: 21285143
Neuropsychopharmacology. 2012 Aug;37(9):1975-85
pubmed: 22473055
Biol Psychiatry. 2008 Sep 15;64(6):461-7
pubmed: 18639234
Eur Neuropsychopharmacol. 2014 Aug;24(8):1229-39
pubmed: 24950819