Letter to the Editor

Howard, Andrew; Honey, Christopher R.; Hurwitz, Trevor A.; Ilcewicz-Klimek, Magdalena; Woo, Cindy; Lam, Raymond W.; Berman, Nicola

doi:10.3171/2011.7.jns111102

Cited by 3 publications

(5 citation statements)

References 4 publications

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“…The occurrence of DBS discontinuation should be regarded as an important safety aspect, because the rapid (re-) occurrence of symptoms could constitute a medical emergency. Suicidality, suicidal ideation and non-compliance to the treatment are the most worrisome aspects in the described scenarios [37]. Battery depletion as well as IPG replacements must be monitored carefully and patients need to be informed about such incidents.…”

Section: Discussionmentioning

confidence: 99%

“…In OCD, discontinuation effects have been described for DBS of the VC [23,24], the ALIC [20,25,[27][28][29], the NAcc [26,31] and the STN [30]. Most studies as well as cases describing DBS cessation in TRD are reported for the stimulation of the SCG [16,33,34,37,39,40,43]. Discontinuation of stimulation of the ALIC and VC has been reported in four articles [17,32,36,41], while there is only one article briefly mentioning the cessation of NAcc-DBS [42] and a case series about slMFB-DBS in TRD [38].…”

Section: Discussionmentioning

confidence: 99%

“…Altogether, the briefly mentioned descriptions as well as detailed reports link the interruption of DBS of different brain targets to a clear worsening of depressive symptoms, although different time courses are described. While some patients experienced a slow and gradual decline of symptoms over a period of four to six weeks [33], worsening of depression occurred rather rapidly in other cases [34,37]. The restoration of stimulation always led to an improvement of symptoms.…”

Section: Treatment-resistant Depression (Trd)mentioning

confidence: 98%

“…Three reports describe the effects of an unintended discontinuation of DBS in six cases in detail [36][37][38]. In one case, classified as responder to DBS of the subcallosal cingulate gyrus (SCG), sudden battery depletion after 26 months resulted in a suicide attempt as well as sudden increase of suicidal thoughts when battery was again depleted 56 months after DBS onset [37]. Four cases of slMFB-DBS experienced different time courses until a worsening of depressive symptoms occurred [38].…”

Section: Treatment-resistant Depression (Trd)mentioning

confidence: 99%

“…In some cases, re-onset of stimulation was associated with an improvement of depressive symptoms within two to four weeks [33], while it took several months in another case [17]. Even in the same patient, time courses to regain symptom levels before discontinuation differed between a very rapid stabilization of mood within 24 h and a slower improvement within two to four weeks [37,38].…”

Section: Treatment-resistant Depression (Trd)mentioning

confidence: 99%

See 4 more Smart Citations

Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Kilian

Bewernick

Klein

et al. 2020

Psych

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Deep brain stimulation (DBS) is currently under research for the treatment of psychiatric disorders, e.g., obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Since the application of DBS in psychiatry has been in use for about 20 years, it is necessary to evaluate its long-term use now. A main issue in the long-term treatment of DBS concerns the effects of a discontinuation of stimulation due to intended as well as unintended reasons. In this contribution, the literature describing discontinuation effects following DBS in OCD and TRD is reviewed. Furthermore, a patient is reported in depth who experienced an unintended discontinuation of supero-lateral medial forebrain bundle (slMFB) DBS for TRD. In this case, the battery was fully depleted without the patient noticing. DBS had led to a sustained response for seven years before discontinuation of stimulation for just several weeks caused a progressive worsening of depression. Altogether, the rapid occurrence of symptom worsening, the absence of a notification about the stimulation status and the difficulties to recapture antidepressant response represent important safety aspects. For a further understanding of the described effects, time courses until worsening of depression as well as biological mechanisms need to be investigated in double-blind controlled trials.

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Section: Discussionmentioning

confidence: 99%