Deep brain stimulation: from neurology to psychiatry?

Area of Science:

• Neurosurgery
• Neurology
• Psychiatry

Background:

• Functional stereotaxy historically aimed to reduce lobotomy morbidity via focal lesions.
• Psychosurgery declined significantly with the advent of neuroleptics.
• Functional stereotactic neurosurgery has seen a resurgence, notably with Deep Brain Stimulation (DBS) for Parkinson's disease.

Purpose of the Study:

• To review the revitalization of functional stereotactic neurosurgery.
• To explore the application of DBS in treating neuropsychiatric disorders.
• To discuss the underlying concept of cortico-basal ganglia-thalamocortical loop dysfunction in these conditions.

Main Methods:

• Review of historical and recent literature on functional stereotaxy and DBS.
• Discussion of the neurobiological underpinnings of various neurological and psychiatric disorders.
• Analysis of the role of basal ganglia circuits in disease pathophysiology.

Main Results:

• Deep Brain Stimulation (DBS) enables reversible, focal neuromodulation of basal ganglia circuits.
• DBS is increasingly applied to neuropsychiatric conditions including OCD, depression, addiction, and Tourette syndrome.
• The concept of dysfunctional cortico-basal ganglia-thalamocortical loops provides a unifying framework for these disorders.

Conclusions:

• Functional stereotactic neurosurgery, particularly DBS, represents a significant advancement in treating neurological and psychiatric disorders.
• Targeting altered basal ganglia circuits offers a promising therapeutic strategy.
• Further research into these circuits may expand DBS applications to a wider range of conditions.