Psychosurgery Makes Gentle Comeback

/ Author:  / Reviewed by: Joseph V. Madia, MD

Psychosurgery is making a comeback. Recently published case series have shown encouraging results of so-called deep brain stimulation (DBS) in treatment-resistant obsessive-compulsive disorder, depressive disorders and Tourette syndrome.

In the current issue of Deutsches Ärzteblatt International, authors Jens Kuhn, of the University of Cologne, and Theo P. J. Gründer, of the Max Planck Institute in Cologne, and their coauthors provide an introduction to the method.

To determine the clinical utility of DBS in psychiatric disorders, the authors evaluated therapeutic studies from 1980 to 2009. They found improvement rates of between 35 and 70 percent in treatment-resistant obsessive-compulsive disorder, depression and Tourette syndrome. The rate of side effects associated with DBS was usually low and mostly reversible by modulating the stimulation parameters.

This favorable side effect profile is not all that surprising because DBS is a well-known procedure  in use for 20 years. In Parkinson's disease and essential tremor, the method has proved to be so effective it has been licensed as a therapeutic option for many years.

To administer DBS, two electrodes are implanted into the patient that deliver continuous, high-frequency, short electrical impulses, enabling modulation of the functional neuronal circuits. The electrodes are connected via a cable to an impulse generator, which is usually implanted below the collarbone.

Although DBS seems to offer new perspectives for treating psychiatric disorders, further studies into its efficacy, mechanisms of action and side effect profile--and especially its long-term course--are needed.

Dr. Jens Kuhn

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Review Date: 
September 20, 2010