Neurosurgical neuromodulation therapy for psychiatric disorders

Summary & key facts

Many people with mental health disorders do not get better with standard treatments. Doctors are studying ways to change brain activity directly using implanted devices or focused ultrasound. Right now, deep brain stimulation with implants is approved in the United States for obsessive-compulsive disorder. Vagus nerve stimulation is approved for some people with depression. New techniques, like MRI-guided focused ultrasound that does not require surgery, look promising, but the research so far is early and larger studies are needed.

Key facts:

• Mental health disorders cause a lot of disability worldwide, and a substantial number of people do not improve with the best available treatments.
• Deep brain stimulation places a small implanted device to change brain circuits. In the United States, it is an approved neurosurgical treatment for obsessive-compulsive disorder.
• Vagus nerve stimulation is an FDA-approved neurosurgical option for some cases of depression.
• Doctors are testing deep brain stimulation for treatment-resistant depression, addiction, and other psychiatric disorders, but the studies so far are small and lack the larger controlled trials needed to prove effectiveness.
• MRI-guided focused ultrasound is a newer, noninvasive method that can target deep brain areas like implanted devices do. Early results are encouraging, but this approach is still investigational.

Abstract

Psychiatric disorders are among the leading contributors to global disease burden and disability. A significant portion of patients with psychiatric disorders remain treatment-refractory to best available therapy. With insights from the neurocircuitry of psychiatric disorders and extensive experience of neuromodulation with deep brain stimulation (DBS) in movement disorders, DBS is increasingly being considered to modulate the neural network in psychiatric disorders. Currently, obsessive-compulsive disorder (OCD) is the only U.S. FDA (United States Food and Drug Administration) approved DBS indication for psychiatric disorders. Medically refractory depression, addiction, and other psychiatric disorders are being explored for DBS neuromodulation. Studies evaluating DBS for psychiatric disorders are promising but lack larger, controlled studies. This paper presents a brief review and the current state of DBS and other neurosurgical neuromodulation therapies for OCD and other psychiatric disorders. We also present a brief review of MR-guided Focused Ultrasound (MRgFUS), a novel form of neurosurgical neuromodulation, which can target deep subcortical structures similar to DBS, but in a noninvasive fashion. Early experiences of neurosurgical neuromodulation therapies, including MRgFUS neuromodulation are encouraging in psychiatric disorders; however, they remain investigational. Currently, DBS and VNS are the only FDA approved neurosurgical neuromodulation options in properly selected cases of OCD and depression, respectively.

Topics

Electroconvulsive Therapy Studies Neurological disorders and treatments Transcranial Magnetic Stimulation Studies

Categories

Health Sciences Medicine Neurology

Tags

Central nervous system Deep brain stimulation Disease Internal medicine Medicine Neurology Neuromodulation Neuroscience Neurosurgery Parkinson's disease Psychiatry Psychology

Conditions & symptoms

Addiction Depression Obsessive-Compulsive Disorder Addiction or harmful habbits Sadness or low mood