Deep Brain Stimulation: A New Frontier in Psychiatry

298 Pages·2012·5.499 MB·English

by  F. L. H. Gielen, G. C. Molnar (auth.), Damiaan Denys, Matthijs Feenstra, Rick Schuurman (eds.)

Deep Brain Stimulation
Damiaan Denys Matthijs Feenstra
•
Rick Schuurman
Editors
Deep Brain Stimulation
A New Frontier in Psychiatry
123
Editors
Damiaan Denys
Department of Psychiatry
Academic Medical Center,University ofAmsterdam
Amsterdam
The Netherlands
and
Neuromodulation and Behaviour
Netherlands InstituteforNeuroscience
Amsterdam
The Netherlands
MatthijsFeenstra
Neuromodulation and Behaviour
Netherlands InstituteforNeuroscience
Amsterdam
The Netherlands
RickSchuurman
Department of Neurosurgery
Academic Medical Center,University ofAmsterdam
Amsterdam
The Netherlands
ISBN 978-3-642-30990-8 ISBN 978-3-642-30991-5 (eBook)
DOI 10.1007/978-3-642-30991-5
SpringerHeidelbergNewYorkDordrechtLondon
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(cid:2)Springer-VerlagBerlinHeidelberg2012
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Foreword
Deepbrainstimulation(DBS)makesitpossibleforpsychosurgerytogetasecond
chance.Inparticular,itdoes thoseproud who initiatedthe method and developed
it for new indications. It permitted the rebirth ofpsychosurgery.But, on the other
hand and at the same time, the reappearance of psychosurgery because of the
merits of DBS, also has threatening aspects since one should not forget the dark
ages of malpractice and overuse of psychosurgery, that led the discipline into
dismay and even into oblivion. The advent of psychosurgery was a huge wave of
hope. One could get rid of the plague of mental disorders, affecting hundreds of
thousands of people who, because of lack of treatment as well as understanding,
wereconfinedbysocietytoprisonsor,camps,orlatertomorehumaneplacessuch
as asylums and psychiatric hospitals. Unfortunately, because of the haste of
application,thelackofwisdom,thedesiretoexploitthisnewmedicalopportunity,
andalsothe distortedmanner inwhich it wasapplied tomodify the brainand the
mind of patients, and even of healthy persons, psychosurgery was finally banned
for the treatment of mental disorders.
For a long period, it was almost obscene to mention terms such as lobectomy,
psychosurgery, and even electroconvulsive therapy. The new era, which is
announced by the current book, was possible only because surgeons and psychi-
atristsintheUSAandEuropekeptpursuingthehardworktohealtheirpatientsin
the most cautious and meritorious way. The breakthrough came from neurosci-
entists using the newly developed functional imaging methods to build up a new
model to understand the anatomical structures involved in consciousness, the
mind, and behavior. Presenting a new scheme of the organization of the basal
ganglia to understand mood and anxiety disorders, is in my view of paramount
importance,similartotheworkthathasbeendoneformovementdisorders.Itwill
be a milestone on the future road for the treatment of mental disorders.
DBS was an appropriate tool to translate the newly formed anatomofunctional
concepts into therapy-oriented surgical strategies. The experience acquired in a
large range of indications demonstrates the validity of the functional inhibition
concept.Thelong-termfollow-upofcohortsofpatientswillestablishthemeritsof
DBS:precision andadaptability,leadingtolowmorbidityandminimalmortality.
v
vi Foreword
Above all, the reversibility of the effects of DBS is important since it minimizes
theriskofirreversiblechangesofbehavior,mood,andpersonality,whichhaunted
the outcome of early lesioning surgery. We now have the right tool, an adequate
scalpel, to perform surgery for the treatment of mental disorders again. We must
take advantage of the unique opportunity to precisely locate the right targets, and
doing so to, increase our knowledge of the physiology of the mind and its dis-
turbances. We have to do this only for the patients’ benefit. We have to resist the
temptation of achieving spectacular changes or to be driven by technology. We
havetobeextremelycautiousinselectingpatients,inanalyzingindications,andin
evaluating the results, and we have to report them carefully to the medical com-
munity.We havetobeawareofourhugesocietalresponsibility,andbeingproud
of this privilege, not to miss the second chance that DBS offers to treat, and who
knows, to cure, mental illnesses.
Clinatec Institute, CEA, Grenoble, France Alim Louis Benabid
Preface
Deep brain stimulation (DBS) was introduced in the 1980s for the treatment of
therapy-resistant neurological disorders, and has been applied since 2000 on an
experimental basis for the treatment of therapy-resistant psychiatric disorders.
Since its introduction, DBS has evolved into a well-accepted therapy to treat
patients with movement disorders, but the use of electrical stimulation to inten-
tionally alter emotion, motivation, and cognition of psychiatric patients often
causes amazement and even disbelief. Neurosurgery for the treatment of psychi-
atric disorders has always been and still is surrounded by controversy.
The relation between DBS and psychiatry is fascinating because it is both
appealing and threatening. First, DBS for the treatment ofpsychiatric disorders is
attractivebecauseitoffersanultimatetreatmentoptionforagroupofseriouslyill,
untreatable psychiatric patients. Second, the risk of the operation is relatively
smallandthetechniquerendersthepossibilityofcontinualadjustment,whichisan
importantissueforpsychiatricpatients.Finally,DBShasthepotentialtoincrease
ourunderstandingofthebrainpathophysiologyofpsychiatricdisorders;itoffersa
view into the pathological brain. DBS is also threatening because psychiatric
disorders are less discrete and objectifiable conditions than movement disorders.
Second, psychiatric symptoms are more intimately connected with a person’s
identity and integrity than motor symptoms, therefore raising more challenging
ethical issues. Finally, the boundary between treatment and enhancement in psy-
chiatryisvague.Alteringcognition,emotion,andmotivationisanintendedgoalin
psychiatryandnotasideeffect,andmayresultinchangesbeyondthenaturalself.
In the past decade, DBS has been applied in obsessive–compulsive disorder,
major depressive disorder, Tourette syndrome, and addiction. The results have
consistently shown a promising success rate. However, the number of patients
treated world-wide is still only limited and most reports deal with small-scale
studies or case reports. Moreover, little is still known about how DBS acts in
psychiatry, emphasizing the need for translational animal studies.
ThepurposeofthisbookistoconductthefirstcomprehensiveoverviewofDBS
in psychiatric disorders, with a particular emphasis on the relation between pre-
clinical animal studies and clinical patient studies. The book starts with the basic
vii
viii Preface
principles of stimulation (Chap. 1), neuroanatomical circuits (Chap. 2), and
hypotheses of the mechanism of action (Chap. 3). Separate chapters subsequently
review DBS in different psychiatric disorders and animal models: obsessive–
compulsive disorder (Chaps. 4–7), major depressive disorder (Chaps. 8–11),
Tourette syndrome (Chap. 12), addiction (Chaps. 13, 14), and psychiatric symp-
toms in Parkinson’s disease (Chaps. 15, 16). We have also included a discussion
on the role of intracranial recordings (Chap. 17), neurotransmitter changes
(Chaps. 18), glial cells (Chap. 19), the significance of animal studies (Chap. 20),
neuroimaging (Chap. 21), and optogenetics (Chap. 22). The future of next-gen-
eration electrodes (Chap. 23) and nanotechniques (Chap. 24) is reviewed, and we
endwithadiscussion ofethicalissuesofDBSinpsychiatricdisorders(Chap.25)
and a critical review of the history of DBS (Chap. 26).
Wethanktheauthors,allexpertsintheirfield,fortheirexcellentcontributions
to this compendium of DBS in psychiatric disorders. We greatly appreciate the
editorialworkofRenskevanDijkinthecreationofthisbook.Wesincerelyhope
that this compilation of present-day knowledge will contribute to increased
understandingacrosstheboundariesofseparatespecialtiesandresearchareas,and
thatitmaybeofhelpinguidingfuturestepsforallthoseinvolvedtoadvancethe
knowledge and application of DBS in psychiatric disorders.
Damiaan Denys
Matthijs Feenstra
Rick Schuurman
Contents
1 Basic Principles of Deep Brain Stimulation. . . . . . . . . . . . . . . . . 1
F. L. H. Gielen and G. C. Molnar
2 Neural Circuits Affected by Deep Brain Stimulation
for the Treatment of Psychiatric Disorders . . . . . . . . . . . . . . . . . 11
Suzanne N. Haber and Benjamin D. Greenberg
3 Mechanisms of Action of Deep Brain Stimulation
for the Treatment of Psychiatric Disorders . . . . . . . . . . . . . . . . . 21
J. Luis Lujan and Cameron C. McIntyre
4 Deep Brain Stimulation in the Ventral Capsule/Ventral Striatum
for the Treatment of Obsessive–Compulsive Disorder:
Role of the Bed Nucleus of the Stria Terminalis . . . . . . . . . . . . . 35
Loes Gabriëls and Bart Nuttin
5 Deep Brain Stimulation in Obsessive–Compulsive Disorder
Targeted at the Nucleus Accumbens . . . . . . . . . . . . . . . . . . . . . . 43
Pelle P. de Koning, Pepijn van den Munckhof, Martijn Figee,
Rick Schuurman and Damiaan Denys
6 What is the Role of the Subthalamic Nucleus
in Obsessive–Compulsive Disorder? Elements and Insights
from Deep Brain Stimulation Studies . . . . . . . . . . . . . . . . . . . . . 53
William I. A. Haynes and Luc Mallet
7 Obsessive–Compulsive Disorders in Animals. . . . . . . . . . . . . . . . 61
Christine Winter
ix
x Contents
8 Subcallosal Cingulate Cortex Deep Brain Stimulation
for the Treatment of Refractory Mood Disorders:
Evidence and Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Peter Giacobbe, Nir Lipsman and Andres M. Lozano
9 Deep Brain Stimulation of the Human Reward System
as a Putative Treatment for Refractory Major Depression. . . . . . 81
T. E. Schlaepfer, V. A. Coenen and B. H. Bewernick
10 Depression in Humans: The Ventral
Capsule/Ventral Striatum. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Mayur Pandya, Andre Machado and Donald Malone
11 Deep Brain Stimulation in Animal Models of Depression. . . . . . . 103
Brian W. Scott, José N. Nobrega and Clement Hamani
12 Deep Brain Stimulation in Tourette Syndrome . . . . . . . . . . . . . . 113
L. Ackermans, I. Neuner, J. Kuhn and V. Visser-Vandewalle
13 Surgical Treatments for Drug Addictions in Humans. . . . . . . . . . 131
Bomin Sun and Wei Liu
14 Manipulating Addictive Behaviour in Animal Models . . . . . . . . . 141
Rolinka M. C. Schippers, Tommy Pattij and Taco J. De Vries
15 Neuropsychiatric Side Effects of Deep Brain Stimulation
in Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Christine Daniels and Jens Volkmann
16 Psychiatric Aspects of Parkinson’s Disease in Animal Models
of Deep Brain Stimulation of the Subthalamic Nucleus . . . . . . . . 175
S. K. H. Tan, H. Hartung, V. Visser-Vandewalle,
T. Sharp and Y. Temel
17 Scientific Recordings in Deep Brain Stimulation . . . . . . . . . . . . . 183
Michael X. Cohen
18 Neurotransmitter Release During Deep Brain Stimulation. . . . . . 193
Osama A. Abulseoud, Emily J. Knight and Kendall H. Lee
19 The Potential Role of Nonneuronal Cells in the Deep
Brain Stimulation Mechanism. . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Vinata Vedam-Mai, Michael S. Okun and Elly M. Hol