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 (University of Cologne) and Theo P J Gründer (Max Planck Institute, Cologne) and their co-authors provide an introduction to the method (Dtsch Arztebl Int 2010; 107(7)105-13).
In order 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% 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 favourable side effect profile is not all that surprising because DBS is a procedure that is well known; it has been in use for 20 years. In Parkinson's disease and essential tremor, the method has proved to be so effective that 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 the treatment of psychiatric disorders, further studies into its efficacy, mechanisms of action, and side effect profile--and especially its long term course--are needed.