Posttraumatic Stress Disorder: Perspectives for the Use of Deep Brain Stimulation

Abstract

Objectives Deep Brain Stimulation (DBS) has been either approved or is currently under investigation for a number of psychiatric disorders. Materials and Methods We review clinical and preclinical concepts as well as the neurocircuitry that may be of relevance for the implementation of DBS in posttraumatic stress disorder (PTSD). Results PTSD is a chronic and debilitating illness associated with dysfunction in well-established neural circuits, including the amygdala and prefrontal cortex. Though most patients often improve with medications and/or psychotherapy, approximately 20–30% are considered to be refractory to conventional treatments. In other psychiatric disorders, DBS has been investigated in treatment-refractory patients. To date, preclinical work suggests that stimulation at high frequency delivered at particular timeframes to different targets, including the amygdala, ventral striatum, hippocampus and prefrontal cortex may improve fear extinction and anxiety-like behavior in rodents. In the only clinical report published so far, a patient implanted with electrodes in the amygdala has shown striking improvements in PTSD symptoms. Conclusions Neuroimaging, preclinical and preliminary clinical data suggest that the use of DBS for the treatment of PTSD may be practical but the field requires further investigation.

Brain circuit dysfunction in post-traumatic stress disorder: from mouse to man

“…There is currently some effort underway to develop transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) interventions for PTSD 157–161 . Although the invasiveness of DBS is likely to mean that such treatments would be reserved for only the most intractable of cases, the use of TMS has been steadily increasing as a therapeutic tool in psychiatry.…”

Beyond Emotions: Oscillations of the Amygdala and Their Implications for Electrical Neuromodulation

“…DBS of the BLA led to a reduction of anxiety and improvements in sleeping pattern (Langevin et al, 2016). In PTSD patients, the amygdala is overactive in response to trauma-related stimuli, but also during unrelated emotional tasks and at rest (Reznikov and Hamani, 2017) and DBS might normalize its activity. Given the potential of amygdala DBS to treat PTSD, a larger clinical trial has been proposed, but results are not published yet (Koek et al, 2014).…”

DBS in Treatment of Post-Traumatic Stress Disorder

“…Patients with total CAPS score ≥85 at the end of baseline period could be kept in the study. The leads (Model 3387, Medtronic Minneapolis, USA) were implanted bilaterally in the BLA with standard precoronal trajectory and stimulation started four weeks after the implant with progressive increase of stimulation parameters to a maximum of 7 V, 200 Hz, and 210 μs [ 29 , 30 ]. A positive clinical response is defined as a 30% reduction in CAPS [ 31 ] from baseline and a Clinical Global Impression-Improvement (CGI-I) [ 32 ] score of 1 (very much improved) or 2 (much improved).…”