Our Summary

Deep brain stimulation (DBS) is a technique that has been used for a long time in neurology to treat movement disorders. Recently, researchers have been trying to use DBS for psychiatric illnesses too. Early experiments have shown some good results for people with obsessive-compulsive disorder (OCD) that doesn’t respond to other treatments. There have also been some hopeful findings for using DBS to treat depression that doesn’t get better with other treatments. However, the two trials that were done to try and get FDA approval for this use didn’t work out. Looking ahead, scientists are considering other ways to run clinical trials, using tractography (a method to visualize nerve pathways) to better target the DBS electrodes, and using closed-loop DBS approaches.

FAQs

  1. What is deep brain stimulation and how is it used in neurology?
  2. How has deep brain stimulation been effective in treating treatment-refractory obsessive-compulsive disorder?
  3. Why were the two controlled trials for FDA approval of deep brain stimulation for treatment-resistant depression unsuccessful?

Doctor’s Tip

A doctor might tell a patient undergoing brain surgery to carefully follow all post-operative instructions, including taking prescribed medications, attending follow-up appointments, and avoiding strenuous activities until cleared by their medical team. It is also important for the patient to communicate any new or worsening symptoms to their healthcare provider promptly.

Suitable For

Patients who are typically recommended for brain surgery are those with severe and treatment-resistant neurological or psychiatric conditions such as movement disorders, treatment-refractory obsessive-compulsive disorder, and treatment-resistant depression. These patients have not responded to traditional treatments and may benefit from the surgical intervention of deep brain stimulation. It is important for patients to undergo a thorough evaluation by a multidisciplinary team of healthcare providers to determine if they are suitable candidates for brain surgery.

Timeline

Before brain surgery:

  • Patient consults with a neurosurgeon and other healthcare professionals to discuss the potential benefits and risks of the procedure
  • Patient undergoes pre-operative testing such as MRI or CT scans to determine the exact location of the brain target for surgery
  • Patient may need to undergo psychological evaluation to assess their mental health and suitability for the procedure
  • Patient may need to make lifestyle changes or take medications to prepare for surgery

After brain surgery:

  • Patient is closely monitored in the hospital for complications such as infection or bleeding
  • Patient may experience temporary side effects such as headaches, fatigue, or changes in mood or personality
  • Patient undergoes regular follow-up appointments with their healthcare team to monitor their recovery and adjust medications or therapy as needed
  • Patient may undergo rehabilitation or therapy to help regain function or alleviate symptoms related to their condition
  • Patient may experience improvements in their symptoms over time as the brain heals and adjusts to the effects of the surgery

What to Ask Your Doctor

  1. What specific condition or symptoms are you recommending brain surgery for?
  2. What are the potential risks and complications associated with this type of surgery?
  3. What are the expected outcomes or benefits of the surgery?
  4. How long is the recovery process and what can I expect during this time?
  5. Are there any alternative treatments or therapies that I should consider before opting for brain surgery?
  6. How experienced are you in performing this type of surgery?
  7. What type of anesthesia will be used during the surgery?
  8. Will I need to undergo any additional tests or evaluations before the surgery?
  9. Will I need to follow any specific guidelines or restrictions after the surgery?
  10. What is the long-term prognosis for my condition after the surgery?

Reference

Authors: Dougherty DD. Journal: Psychiatr Clin North Am. 2018 Sep;41(3):385-394. doi: 10.1016/j.psc.2018.04.004. Epub 2018 Jul 17. PMID: 30098652