Application of Deep Brain Stimulation in Refractory Post-Traumatic Stress Disorder

Abstract

Post-traumatic stress disorder (PTSD) is a mental disorder that produces crippling anxiety and occurs in response to an extreme, traumatic stressor. Compared to the prevalence of PTSD in the general population, the prevalence of PTSD in at-risk populations (e.g., army veterans, those affected by environmental calamities, and others) can reach up to threefold. The conventional treatment of PTSD involves using SSRIs (serotonin reuptake inhibitors) and other anti-depressants along with psychotherapy such as debriefing and CBT (cognitive behavioral therapy). Due to increasing resistance to conventional treatment, more novel treatment options, such as stellate ganglion block shots and neuromodulation, are being explored. These neuromodulation techniques include transcranial magnetic stimulation (TMS), transcranial direct current stimulation (TDS), and deep brain stimulation (DBS). The rationale behind employing these techniques in refractory PTSD is the altered neurocircuitry seen in PTSD patients, which can be visualized on imaging. Studies involving the use of DBS for PTSD primarily target specific areas in the brain: the amygdala, the prefrontal cortex, the hippocampus, and the hypothalamus. This article aims to provide a brief overview of the various neuromodulation techniques currently employed in the management of treatment-resistant PTSD and an in-depth review of the available literature on animal models in which DBS for PTSD has been researched. We also shed light on the human clinical trials conducted for the same.

Keywords: deep brain stimulation; neuromodulation; neurostimulation; post traumatic stress disorder; post traumatic stress disorder (ptsd); ptsd; shell shock syndrome.

Figure 1. PRISMA flowchart describing record selection

Figure 2. The hyperactive (red) and hypoactive (blue) areas of the brain in PTSD

dACC: dorsal anterior cingulate cortex; dmPFC: dorsomedial prefrontal cortex; mPFC: medial prefrontal cortex; OFC: orbitofrontal cortex; vmPFC: ventromedial prefrontal cortex; AMYG: amygdala; BLn: basolateral nucleus of the amygdala; HIP: hippocampus