Deep Brain Stimulation for Psychiatric Disorders

Larson, Paul

doi:10.1016/j.nurt.2007.11.006

Cited by 73 publications

(41 citation statements)

References 53 publications

(53 reference statements)

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“…581 There is also an interest in the potential of DBS to target brain areas associated with compulsive behaviors and depression that might be of value for patients with PD. 582 These observations underscore the early stage of development of DBS and the clinical research yet to be done to refine how DBS might be applicable to the treatment of specific PD symptoms.…”

Section: Disadvantagesmentioning

confidence: 98%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

760

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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Section: Disadvantagesmentioning

confidence: 98%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

760

658

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“…3,7 The application of DBS to psy chiatric diseases such as depression represents a para digm shift in therapy and raises important ethical issues. [8][9][10]16 Advances in neurosurgical technology and neuroimaging are stirring intense debates regarding potential applications of neuromodulation. The use of DBS to treat obesity, the development of a brainmachine interface to facilitate independence for paralyzed patients, and the potential use of functional imaging for "lie detection" underscores both the concerns and promise regarding technical advances.…”

mentioning

confidence: 99%

Neurosurgeons' perspectives on psychosurgery and neuroenhancement: a qualitative study at one center

Mendelsohn¹,

Lipsman²,

Bernstein³

2010

JNS

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Object. Advances in the neurosciences are stirring debate regarding the ethical issues surrounding novel neurosurgical interventions. The application of deep brain stimulation (DBS) for treating refractory psychiatric disease, for instance, has introduced the prospect of altering disorders of mind and behavior and the potential for neuroenhancement. The attitudes of current and future providers of this technology and their position regarding its possible future applications are unknown. The authors sought to gauge the opinions of neurosurgical staff and trainees toward various uses of neuromodulation technology including psychosurgery and neuroenhancement.Methods. The authors conducted a qualitative study involving indepth interviews with 47 neurosurgery staff, trainees, and other neuroclinicians at a quaternary care center.Results. Several general themes emerged from the interviews. These included universal support for psychosurgery given adequate informed consent and rigorous scientific methodology, as well as a relative consensus regarding the priority given to patient autonomy and the preservation of personal identity. Participants' attitudes toward the future use of DBS and other means of neuromodulation for cognitive enhancement and personality alteration revealed less agreement, although most participants felt that alteration of nonpathological traits is objectionable.Conclusions. There is support in the neurosurgical community for the surgical management of refractory psychiatric disease. The use of neuromodulation for the alteration of nonpathological traits is morally and ethically dubious when it is out of sync with the values of society at large. Both DBS and neuromodulation will have farreaching and profound public health implications. (DOI: 10.3171/2010.5.JNS091896) key WorDs • enhancement • neuroethics • personal identity • psychosurgeryAbbreviations used in this paper: DBS = deep brain stimulation; GKS = Gamma Knife surgery; OCD = obsessivecompulsive disorder; PTSD = posttraumatic stress disorder.

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“…Esta última recibe el nombre de estimulación cerebral profunda (ECP o DBS, por sus iniciales en inglés). Los criterios de inclusión y los parámetros de estimulación para pacientes parkinsonianos que reciben ECP varían ampliamente de acuerdo a cada valoración neurológica en particular, pero se ha utilizado exitosamente para cuadros de trastorno obsesivo compulsivo (Benabid & Torres, 2012;Kopell & Greenberg, 2008;Rezai, 2009), epilepsia (Jaseja, Gupta, Jain, & Gupta, 2014;Van et al, 2015;Mottonen et al, 2016), depresión (Cusin & Dougherty, 2013;Okun et al, 2014;Berlim, McGirr, Van den Eynde, Fleck, & Giacobbe, 2014;Quraan et al, 2014;Lilleeng, Gjerstad, Baardsen, Dalen, & Larsen, 2015;Williams et al, 2016) & Beuls, 2004;Sakas et al, 2007;Larson, 2008;Marks, Honeycutt, Acosta, & Reed, 2009).…”

Section: Estimulación Cerebral Profunda (Ecp)unclassified

La Enfermedad de Parkinson: Etiología, Tratamientos y Factores Preventivos

Hurtado

Cárdenas

et al. 2017

Univ Psychol

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RESUMENLa enfermedad de Parkinson (EP) es la patología neurodegenerativa motora con mayor incidencia a nivel mundial, cuyas causas aún no son claras. Actualmente no existe cura, pero es posible contar con diferentes tratamientos que permiten aliviar algunos de sus síntomas y enlentecer su curso. Debido a la gran cantidad de informaciones, en ocasiones contradictorias sobre los llamados "factores de riesgo" (entendidos éstos como situaciones que pueden exacerbar la posibilidad de aparición de la enfermedad, incluyendo desde la predisposición familiar hasta la exposición prolongada a substancias exógenas), en esta revisión se pretende ofrecer una panorámica actual sobre factores asociados a la aparición de EP. Se revisan también algunos tratamientos que buscan contrarrestar la pérdida de la función dopaminérgica de la substancia nigra (SN) y algunas de las aproximaciones terapéuticas tanto farmacológicas, como por estimulación cerebral profunda (ECP) o por implante celular. Se revisan también investigaciones sobre el potencial terapéutico de compuestos con alta especificidad a receptores colinérgicos (nAChRs) y antagonistas de receptores de adenosina, específicamente del subtipo A2A. Posiblemente durante las próximas décadas, nuestro conocimiento en epigenética pueda arrojar nuevas luces sobre esta interacción, así como sobre las relaciones entre ciertas líneas de microbios intestinales y aparición de EP. En este momento, la alternativa terapéutica que ofrece mayor eficacia es la ECP, sin embargo, a futuro se espera que el desarrollo de nuevas estrategias de implante cerebral pueda ofrecer una cura real de la EP. Palabras claveEnfermedad de Parkinson (EP); estimulación cerebral profunda (ECP); sustancia nigra (SN); núcleo subtálamico (NST); globo pálido interno (GPi). ABSTRACTParkinson's disease (PD) is the most prevalent neurodegenerative motor pathology worldwide, the causes of which are still unclear. Currently there is no cure, but it is possible to have different treatments that allow to alleviate some of its symptoms and slow its course. Due to the large amount of information, sometimes contradictory, about the

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Deep Brain Stimulation for Psychiatric Disorders

Cited by 73 publications

References 53 publications

The scientific and clinical basis for the treatment of Parkinson disease (2009)

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Neurosurgeons' perspectives on psychosurgery and neuroenhancement: a qualitative study at one center

La Enfermedad de Parkinson: Etiología, Tratamientos y Factores Preventivos

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