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Deep brain stimulation for psychiatric diseases: what are the risks?
Christian Saleh1, Denys Fontaine
1Service de Neurochirurgie, Centre Hospitalier Universitaire de Nice (CHU), Nice, France, chs12us75010@yahoo.com.
Current Psychiatry Reports
|March 22, 2015
Summary
Deep brain stimulation (DBS) for psychiatric disorders like OCD and depression shows low surgical mortality. While most complications are temporary, long-term risks exist, necessitating careful patient monitoring.
Area of Science:
- Neurosurgery
- Psychiatry
- Medical Technology
Background:
- Deep brain stimulation (DBS) is an established treatment for psychiatric disorders, including obsessive-compulsive disorder (OCD), Gilles de la Tourette Syndrome (GTS), and treatment-refractory depression (TRD).
- Patient and clinician apprehension regarding surgical risks limits the adoption of DBS for psychiatric conditions.
- A comprehensive understanding of the safety profile of DBS in psychiatric applications is crucial for wider clinical acceptance.
Purpose of the Study:
- To systematically evaluate the surgical risks and complications associated with deep brain stimulation (DBS) for psychiatric disorders.
- To analyze existing literature to quantify the prevalence and nature of adverse events in patients undergoing DBS for OCD, GTS, and TRD.
Main Methods:
- A PubMed search identified 49 articles reporting on DBS for psychiatric disorders.
- Analysis focused exclusively on studies detailing complications, including 272 patients with a mean follow-up of 22 months.
- Data on surgical mortality, overall mortality, transient and long-term morbidity, and permanent neurological complications were extracted and analyzed.
Main Results:
- Surgical mortality was zero. Overall mortality was 1.1%, with deaths attributed to suicide or unlikely related to DBS.
- The majority of complications were transient and stimulation-related.
- Long-term morbidity occurred in 16.5% of cases, with permanent neurological complications (intracerebral hemorrhage) in 2.2%.
Conclusions:
- Complications associated with DBS for psychiatric disorders appear comparable to those seen in movement disorder applications, though robust evidence (Class I) is lacking.
- The exact prevalence of complications could not be definitively established due to missing data in many reports.
- DBS for psychiatric diseases holds promise but remains experimental, requiring rigorous patient surveillance and further evaluation.
