Summary
Surgery for psychiatric disorders first began in the early part of the last century when the therapeutic options for these patients were limited. The introduction of deep brain stimulation (DBS) has caused a new interest in the surgical treatment of these disorders. DBS may have some advantage over lesioning procedures used in the past. A critical review of the major DBS targets under investigation for Tourette’s syndrome, obsessive-compulsive disorder, and major depression is presented. Current and future challenges for the use of DBS in psychiatric disorders are discussed, as well as a rationale for referring to this subspecialty as limbic disorders surgery based on the parallels with movement disorders surgery.
Key Words: Deep brain stimulation, Tourette’s syndrome, obsessive-compulsive disorder, major ger pression, treatment-resistant depression, psychosurgery
References
- 1.Feldman RP, Goodrich JT. Psychosurgery: a historical overview. Neurosurgery. 2001;48:647–657. doi: 10.1097/00006123-200103000-00041. [DOI] [PubMed] [Google Scholar]
- 2.El-Hai J. The lobotomist: a maverick medical genius and his tragic quest to rid the world of mental illness. Hoboken, New Jersey: John Wiley & Sons; 2005. [Google Scholar]
- 3.Visser-Vandewalle V, Temel Y, Boon P, et al. Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome. Report of three cases. J Neurosurg. 2003;99:1094–1100. doi: 10.3171/jns.2003.99.6.1094. [DOI] [PubMed] [Google Scholar]
- 4.Houeto JL, Karachi C, Mallet L, et al. Tourette’s syndrome and deep brain stimulation. J Neurol Neurosurg Psychiatry. 2005;76:992–995. doi: 10.1136/jnnp.2004.043273. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Abelson JL, Curtis GC, Sagher O, et al. Deep brain stimulation for refractory obsessive-compulsive disorder. Biol Psychiatry. 2005;57:510–516. doi: 10.1016/j.biopsych.2004.11.042. [DOI] [PubMed] [Google Scholar]
- 6.Nuttin BJ, Gabriels LA, Cosyns PR, et al. Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder. Neurosurgery. 2003;52:1263–1272. doi: 10.1227/01.NEU.0000064565.49299.9A. [DOI] [PubMed] [Google Scholar]
- 7.Machado AG, Hiremath GK, Salazar F, et al. Fracture of subthalamic nucleus deep brain stimulation hardware as a result of compulsive manipulation: case report. Neurosurgery. 2005;57:E1318–E1318. doi: 10.1227/01.NEU.0000187566.01731.51. [DOI] [PubMed] [Google Scholar]
- 8.Mayberg HS, Lozano AM, Voon V, et al. Deep brain stimulation for treatment-resistant depression. Neuron. 2005;45:651–660. doi: 10.1016/j.neuron.2005.02.014. [DOI] [PubMed] [Google Scholar]
- 9.Deep-Brain Stimulation for Parkinson’s Disease Study Group Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson’s disease. N Engl J Med. 2001;345:956–963. doi: 10.1056/NEJMoa000827. [DOI] [PubMed] [Google Scholar]
- 10.Bergman H, Wichmann T, DeLong MR. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science. 1990;249:1436–1438. doi: 10.1126/science.2402638. [DOI] [PubMed] [Google Scholar]
- 11.Mazzone P, Lozano A, Stanzione P, et al. Implantation of human pedunculopontine nucleus: a safe and clinically relevant target in Parkinson’s disease. Neuroreport. 2005;16:1877–1881. doi: 10.1097/01.wnr.0000187629.38010.12. [DOI] [PubMed] [Google Scholar]
- 12.Grabli D, McCaim K, Hirsch EC, et al. Behavioural disorders induced by external globus pallidus dysfunction in primates: I. behavioural study. Brain. 2004;127:2039–2054. doi: 10.1093/brain/awh220. [DOI] [PubMed] [Google Scholar]
- 13.Francois C, Grabli D, McCaim K, et al. Behavioural disorders induced by external globus pallidus dysfunction in primates II. anatomical study. Brain. 2004;127:2055–2070. doi: 10.1093/brain/awh239. [DOI] [PubMed] [Google Scholar]
- 14.Hassler R, Dieckmann G. Stereotaxic treatment of tics and inarticulate cries or coprolalia considered as motor obsessional phenomena in Gilles de la Tourette’s disease. Revue neurologique. 1970;123:89–100. [PubMed] [Google Scholar]
- 15.Vandewalle V, van der Linden C, Groenewegen HJ, et al. Stereotactic treatment of Gilles de la Tourette syndrome by high frequency stimulation of thalamus. Lancet. 1999;353:724–724. doi: 10.1016/S0140-6736(98)05964-9. [DOI] [PubMed] [Google Scholar]
- 16.Temel Y, Visser-Vandewalle V. Surgery in Tourette syndrome. Mov Disord. 2004;19:3–14. doi: 10.1002/mds.10649. [DOI] [PubMed] [Google Scholar]
- 17.Diederich NJ, Kalteis K, Stamenkovic M, et al. Efficient internal pallidal stimulation in Gilles de la Tourette syndrome: a case report. Mov Disord. 2005;20:1496–1499. doi: 10.1002/mds.20551. [DOI] [PubMed] [Google Scholar]
- 18.Ackermans L, Temel Y, Cath D, et al. Deep brain stimulation in Tourette’s syndrome: two targets? Mov Disord. 2006;21:709–713. doi: 10.1002/mds.20816. [DOI] [PubMed] [Google Scholar]
- 19.Coffey BJ, Miguel EC, Biederman J, et al. Tourette’s disorder with and without obsessive-compulsive disorder in adults: are they different? J Nerv Ment Dis. 1998;186:201–206. doi: 10.1097/00005053-199804000-00001. [DOI] [PubMed] [Google Scholar]
- 20.Lippitz BE, Mindus P, Meyerson BA, et al. Lesion topography and outcome after thermocapsulotomy or gamma knife capsulotomy for obsessive-compulsive disorder: relevance of the right hemisphere. Neurosurgery. 1999;44:452–458. doi: 10.1097/00006123-199903000-00005. [DOI] [PubMed] [Google Scholar]
- 21.Sturm V, Lenartz D, Koulousakis A, et al. The nucleus accumbens: a target for deep brain stimulation in obsessive-compulsive- and anxiety-disorders. J Chem Neuroanat. 2003;26:293–299. doi: 10.1016/j.jchemneu.2003.09.003. [DOI] [PubMed] [Google Scholar]
- 22.Greenberg BD, Rice LH, Rauch SL, et al. Neurosurgery for intractable obsessive-compulsive disorder and depression: critical issues. Neurosurg Clin N Am. 2003;14:199–212. doi: 10.1016/S1042-3680(03)00005-6. [DOI] [PubMed] [Google Scholar]
- 23.Dougherty DD, Baer L, Cosgrove GR, et al. Prospective long-term follow-up of 44 patients who received cingulotomy for treatment-refractory obsessive-compulsive disorder. Am J Psychiatry. 2002;159:269–275. doi: 10.1176/appi.ajp.159.2.269. [DOI] [PubMed] [Google Scholar]
- 24.Jenike MA. Neurosurgical treatment of obsessive-compulsive disorder. Br J Psychiatry 1998:79–90. [PubMed]
- 25.Cosgrove GR. Surgery for psychiatric disorders. CNS Spectr. 2000;5:43–52. doi: 10.1017/s1092852900007665. [DOI] [PubMed] [Google Scholar]
- 26.Hodgkiss AD, Malizia AL, Bartlett JR, et al. Outcome after the psychosurgical operation of stereotactic subcaudate tractotomy, 1979–1991. J Neuropsychiatry Clin Neurosci. 1995;7:230–234. doi: 10.1176/jnp.7.2.230. [DOI] [PubMed] [Google Scholar]
- 27.Montoya A, Weiss AP, Rice BH, et al. Magnetic resonance imaging-guided stereotactic limbic leukotomy for treatment of intractable psychiatric disease. Neurosurgery. 2002;50:1043–1049. doi: 10.1097/00006123-200205000-00018. [DOI] [PubMed] [Google Scholar]
- 28.Flaherty AW, Williams ZM, Amimovin R, et al. Deep brain stimulation of the anterior internal capsule for the treatment of Tourette syndrome: technical case report. Neurosurgery. 2005;57:E403–E403. doi: 10.1227/01.NEU.0000176854.24694.95. [DOI] [PubMed] [Google Scholar]
- 29.Rezai A, Friehs G, Malone D, et al. Deep brain stimulation for treatment of intractable major depression: preliminary results from a multi-center prospective trial. Annual Meeting of the American Association of Neurological Surgeons, San Francisco, CA, 2006.
- 30.Haber SN, Fudge JL, McFarland NR. Striatonigrostriatal pathways in primates form an ascending spiral from the shell to the dorsolateral striatum. J Neurosci. 2000;20:2369–2382. doi: 10.1523/JNEUROSCI.20-06-02369.2000. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Heimer L. The legacy of the silver methods and the new anatomy of the basal forebrain: implications for neuropsychiatry and drug abuse. Scand J Psychol. 2003;44:189–201. doi: 10.1111/1467-9450.00336. [DOI] [PubMed] [Google Scholar]
- 32.Nauta WJ, Domesick VB. Afferent and efferent relationships of the basal ganglia. Ciba Found Symp. 1984;107:3–29. doi: 10.1002/9780470720882.ch2. [DOI] [PubMed] [Google Scholar]
- 33.Fontaine D, Mattei V, Borg M, et al. Effect of subthalamic nucleus stimulation on obsessive-compulsive disorder in a patient with Parkinson disease. Case report. J Neurosurg. 2004;100:1084–1086. doi: 10.3171/jns.2004.100.6.1084. [DOI] [PubMed] [Google Scholar]
- 34.Aouizerate B, Cuny E, Martin-Guehl C, et al. Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report. J Neurosurg. 2004;101:682–686. doi: 10.3171/jns.2004.101.4.0682. [DOI] [PubMed] [Google Scholar]
- 35.Mallet L, Mesnage V, Houeto JL, et al. Compulsions, Parkinson’s disease, and stimulation. Lancet. 2002;360:1302–1304. doi: 10.1016/S0140-6736(02)11339-0. [DOI] [PubMed] [Google Scholar]
- 36.Nuttin B, Cosyns P, Demeulemeester H, et al. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999;354:1526–1526. doi: 10.1016/S0140-6736(99)02376-4. [DOI] [PubMed] [Google Scholar]
- 37.McIntyre CC, Savasta M, Kerkerian-Le Goff L, et al. Uncovering the mechanism(s) of action of deep brain stimulation: activation, inhibition, or both. Clin Neurophysiol. 2004;115:1239–1248. doi: 10.1016/j.clinph.2003.12.024. [DOI] [PubMed] [Google Scholar]
- 38.Spiegel EA, Wycis HT, Freed H, et al. A follow-up study of patients treated by thalamotomy and by combined frontal and thalamic lesions. J Nerv Ment Dis. 1956;124:399–404. doi: 10.1097/00005053-195610000-00011. [DOI] [PubMed] [Google Scholar]
- 39.Greenberg BD, Malone DA, Friehs GM, et al. Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder. Neuropsychopharmacology. 2006;31:2384–2393. doi: 10.1038/sj.npp.1301165. [DOI] [PubMed] [Google Scholar]
- 40.Fava M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry. 2003;53:649–659. doi: 10.1016/S0006-3223(03)00231-2. [DOI] [PubMed] [Google Scholar]
- 41.Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 2003; 361:799–808. [DOI] [PubMed]
- 42.Franzini A, Ferroli P, Leone M, et al. Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: first reported series. Neurosurgery. 2003;52:1095–1099. doi: 10.1227/01.NEU.0000057698.29634.D6. [DOI] [PubMed] [Google Scholar]
- 43.Mayberg HS, Liotti M, Brannan SK, et al. Reciprocal limbic-cortical function and negative mood: converging PET findings in depression and normal sadness. Am J Psychiatry. 1999;156:675–682. doi: 10.1176/ajp.156.5.675. [DOI] [PubMed] [Google Scholar]
- 44.Mayberg HS. Modulating dysfunctional limbic-cortical circuits in depression: towards development of brain-based algorithms for diagnosis and optimised treatment. Br Med Bull. 2003;65:193–207. doi: 10.1093/bmb/65.1.193. [DOI] [PubMed] [Google Scholar]
- 45.Schlaepfer TE, Cohen MX, Frick C, et al. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 2007 Apr 11; [Epub ahead of print]. [DOI] [PubMed]
- 46.Mink JW, Walkup J, Frey KA, et al. Patient selection and assessment recommendations for deep brain stimulation in Tourette syndrome. Mov Disord. 2006;21:1831–1838. doi: 10.1002/mds.21039. [DOI] [PubMed] [Google Scholar]
- 47.Rauch SL, Whalen PJ, Curran T, et al. Probing striato-thalamic function in obsessive-compulsive disorder and Tourette syndrome using neuroimaging methods. Adv Neurol. 2001;85:207–224. [PubMed] [Google Scholar]
- 48.Rauch SL, Kim H, Makris N, et al. Volume reduction in the caudate nucleus following stereotactic placement of lesions in the anterior cingulate cortex in humans: a morphometric magnetic resonance imaging study. J Neurosurg. 2000;93:1019–1025. doi: 10.3171/jns.2000.93.6.1019. [DOI] [PubMed] [Google Scholar]
- 49.Rauch SL, Savage CR, Alpert NM, et al. Probing striatal function in obsessive-compulsive disorder: a PET study of implicit sequence learning. J Neuropsychiatry Clin Neurosci. 1997;9:568–573. doi: 10.1176/jnp.9.4.568. [DOI] [PubMed] [Google Scholar]
- 50.Rauch SL, Dougherty DD, Malone D, et al. A functional neuroimaging investigation of deep brain stimulation in patients with obsessive-compulsive disorder. J Neurosurg. 2006;104:558–565. doi: 10.3171/jns.2006.104.4.558. [DOI] [PubMed] [Google Scholar]
- 51.Mink JW. Basal ganglia dysfunction in Tourette’s syndrome: a new hypothesis. Pediatr Neurol. 2001;25:190–198. doi: 10.1016/S0887-8994(01)00262-4. [DOI] [PubMed] [Google Scholar]
- 52.Mink JW. Neurobiology of basal ganglia circuits in Tourette syndrome: faulty inhibition of unwanted motor patterns? Adv Neurol. 2001;85:113–122. [PubMed] [Google Scholar]
