Current and future directions of deep brain stimulation for neurological and psychiatric disorders

Abstract

Deep brain stimulation (DBS) has evolved considerably over the past 4 decades. Although it has primarily been used to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia, recently it has been approved to treat obsessive-compulsive disorder and epilepsy. Novel potential indications in both neurological and psychiatric disorders are undergoing active study. There have been significant advances in DBS technology, including preoperative and intraoperative imaging, surgical approaches and techniques, and device improvements. In addition to providing significant clinical benefits and improving quality of life, DBS has also increased the understanding of human electrophysiology and network interactions. Despite the value of DBS, future developments should be aimed at developing less invasive techniques and attaining not just symptom improvement but curative disease modification.

Keywords: ACC = anterior cingulate cortex; AD = Alzheimer’s disease; ADAS-Cog = Alzheimer’s Disease Assessment Scale, Cognitive Subscale; ALIC = anterior limb of the internal capsule; ANT = anterior nucleus of the thalamus; BNST = bed nucleus of the stria terminalis; CMPfc = centromedian–parafascicular complex; DBS = deep brain stimulation; ET = essential tremor; GPi = globus pallidus pars interna; ITP = inferior thalamic peduncle; NAc = nucleus accumbens; OCD = obsessive-compulsive disorder; PAG/PVG = periaqueductal gray/periventricular gray; PD = Parkinson’s disease; PTSD = posttraumatic stress disorder; Parkinson’s disease; STN = subthalamic nucleus; VC/VS = ventral capsule/ventral striatum; VPL/VPM = ventral posterior lateral nucleus/ventral posterior medial nucleus; Vim = ventral intermediate thalamic nucleus; area LC = locus of the caudate neurons; deep brain stimulation; dystonia; epilepsy; essential tremor; functional neurosurgery; nbM = nucleus basalis of Meynert.