A comprehensive review of the use of deep brain stimulation (DBS) in treatment of psychiatric and headache disorders.

ABSTRACT

BACKGROUND: Neurostimulation as a treatment option for refractory neuropsychiatric disorders has been increasingly utilized in recent years. For patients with such refractory disorders who have often failed to respond to various medical interventions, deep brain stimulation (DBS) has emerged as a promising treatment modality. DBS is a reversible and adjustable form of brain stimulation (also known as functional neurosurgery) in which desired brain structures (or circuits) are given focal electric stimulation via electrodes that are implanted in the brain tissue during a surgical procedure. It has been utilized among various psychiatric and neurological illnesses, in particular headache disorders. This article reviews the most relevant data regarding DBS for psychiatric and primary headache disorders. METHODS: Authors conducted a detailed literature search of Medline/PubMed database and studies that used DBS for the treatment of refractory neuropsychiatric disorders were reviewed. Response, remission, and safety measures of these studies were obtained. RESULTS: Despite the advancement in DBS treatment, the number of randomized controlled studies remains very limited due to ethical and methodological difficulties of setting up invasive procedures of this magnitude. So at present, DBS represents a modality used only in the most refractory patients. CONCLUSION: Current data support DBS as a promising treatment option for neuropsychiatric disorders that do not respond to conventional treatments; however, it is clear that more research and patient volume is needed to demonstrate its efficacy in treating these conditions. The use of functional imaging to understand the pathophysiology of these disorders has been crucial for the utilization of DBS.