Neuromodulation in psychiatry

Mayur Sharma, Zion Zibly, Milind Deogaonkar, Ali Rezai

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

The success of deep brain stimulation (DBS) surgery for movement disorders over the past 20 years with over 100,000 patient implants has revived the interest in neurosurgical treatment of refractory psychiatric disorders. The introduction of stereotaxis in the second half of the twentieth century aided with the technological evolutions enabled neurosurgeons to interrupt the white matter tracts while minimizing the cortical damage and thereby the side effects associated with leucotomies/lobotomies. Moreover, the integration of functional imaging, microelectrode recordings and computer based data with stereotaxis made it a robust technique to target the subcortical structures more precisely. With better understanding of the pathophysiology and neural circuits involved in these disorders, it may be possible to delineate the anatomical "target" or "targets" for neuromodulation. The role of cortico-striato-thalamo-cortical (CSTC) loops in the pathophysiology of these psychiatric disorders is well established. Preliminary results suggested the efficacy of this treatment modality in the management of refractory psychiatric disorders such as OCD and MDD and neurostimulation therapy may be an option in the management of these disorders. There are several advantages of neurostimulation therapy over ablation therapy such as reversibility and adjustability according to the patient's symptoms and disease progression and the ability to switch the stimulation without patient's awareness, thereby providing an opportunity for blinding in crossover research studies. The opportunity for surgical intervention is of importance given the large prevalence and the socioeconomic impact of psychiatric disorders, the presence of many refractory and disabled patients, improved understanding of the neural circuitry underlying these conditions, and increasing safety, precision, and technological innovations in the neurosurgical interventions. This chapter focuses on neurosurgery for severe and treatment-refractory psychiatric disorders including history of psychosurgery, ethical considerations, current concepts, and future goals.

Original languageEnglish (US)
Title of host publicationThe Medical Basis of Psychiatry
Subtitle of host publicationFourth Edition
PublisherSpringer New York
Pages847-867
Number of pages21
ISBN (Electronic)9781493925285
ISBN (Print)9781493925278
DOIs
StatePublished - Jan 1 2016
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016 Springer Science+Business Media New York. All rights reserved.

Keywords

  • Cortico-striato-thalamo-cortical loops
  • Deep brain stimulation
  • Major depression
  • Neuromodulation
  • Obsessive-compulsive disorder
  • Psychosurgery

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