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Deep Brain Stimulation for Psychiatric Diseases: What Are the Risks?

  • Mood Disorders (JF Greden, Section Editor)
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Abstract

Despite the application of deep brain stimulation (DBS) as an efficient treatment modality for psychiatric disorders, such as obsessive-compulsive disorder (OCD), Gilles de la Tourette Syndrome (GTS), and treatment refractory major depression (TRD), few patients are operated or included in clinical trials, often for fear of the potential risks of an approach deemed too dangerous. To assess the surgical risks, we conducted an analysis of publications on DBS for psychiatric disorders. A PubMed search was conducted on reports on DBS for OCD, GTS, and TRD. Forty-nine articles were included. Only reports on complications related to DBS were selected and analyzed. Two hundred seventy-two patients with a mean follow-up of 22 months were included in our analysis. Surgical mortality was nil. The overall mortality was 1.1 %: two suicides were unrelated to DBS and one death was reported to be unlikely due to DBS. The majority of complications were transient and related to stimulation. Long-term morbidity occurred in 16.5 % of cases. Three patients had permanent neurological complications due to intracerebral hemorrhage (2.2 %). Complications reported in DBS for psychiatric diseases appear to be similar to those reported for DBS in movement disorders. But class I evidence is lacking. Our analysis was based mainly on small non-randomized studies. A significant number of patients (approximately 150 patients) who were treated with DBS for psychiatric diseases had to be excluded from our analysis as no data on complications was available. The exact prevalence of complications of DBS in psychiatric diseases could not be established. DBS for psychiatric diseases is promising, but remains an experimental technique in need of further evaluation. A close surveillance of patients undergoing DBS for psychiatric diseases is mandatory.

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Abbreviations

AE:

Adverse events

ALIC:

Anterior limb of the internal capsules

BA:

Brodmann area

DBS:

Deep brain stimulation

GTS:

Gilles de la Tourette Syndrome

ECT:

Electroconvulsive therapy

HW:

Hardware

ICH:

Intracranial hemorrhage

MER:

Microelectrode recordings

NA:

Nucleus accumbens

OCD:

Obsessive-compulsive disorder

PD:

Parkinson’s disease

SCG:

Subgenual cingulated gyrus

STN:

Subthalamic nucleus

TRD:

Treatment refractory major depression

VC/VS:

Ventral capsule/ventral striatum

References

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Acknowledgments

We thank Professor Helen Mayberg (Emory University School of Medicine, Atlanta, USA) for the critical review of our manuscript.

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Conflict of Interest

Dr. Christian Saleh declares no conflict of interest.

Professor Denys Fontaine has received board membership fees from Boston Scientific and consultancy fees, paid travel accommodations, and grants from St. Jude ANS and Medtronic. Professor Denys Fontaine has also received payments for development of educational presentations from St. Jude ANS.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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  1. Service de Neurochirurgie, Centre Hospitalier Universitaire de Nice (CHU), Nice, France

    Christian Saleh & Denys Fontaine

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  1. Christian Saleh
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  2. Denys Fontaine
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Correspondence to Christian Saleh or Denys Fontaine.

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This article is part of the Topical Collection on Mood Disorders

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Saleh, C., Fontaine, D. Deep Brain Stimulation for Psychiatric Diseases: What Are the Risks?. Curr Psychiatry Rep 17, 33 (2015). https://doi.org/10.1007/s11920-015-0565-1

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