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Deep brain stimulation: a return journey from psychiatry to neurology
  1. Keyoumars Ashkan1,
  2. Paul Shotbolt2,
  3. Anthony S David3,
  4. Michael Samuel4
  1. 1Department of Neurosurgery, King's College Hospital NHS Foundation Trust, King's Health Partners, London, UK
  2. 2Neuropsychiatry Service, South London and The Maudsley NHS Foundation Trust, King's Health Partners, London, UK
  3. 3Department of Cognitive Neuropsychiatry, Institute of Psychiatry, King's Health Partners, London, UK
  4. 4Department of Neurology, King's College Hospital NHS Foundation Trust, King's Health Partners, London, UK
  1. Correspondence to Keyoumars Ashkan, Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK; k.ashkan{at}nhs.net

Abstract

Deep brain stimulation (DBS) has emerged as an effective neurosurgical tool to treat a range of conditions. Its use in movement disorders such as Parkinson's disease, tremor and dystonia is now well established and has been approved by the National Institute of Clinical Excellence (NICE). The NICE does, however, emphasise the need for a multidisciplinary team to manage these patients. Such a team is traditionally composed of neurologists, neurosurgeons and neuropsychologists. Neuropsychiatrists, however, are increasingly recognised as essential members given many psychiatric considerations that may arise in patients undergoing DBS. Patient selection, assessment of competence to consent and treatment of postoperative psychiatric disease are just a few areas where neuropsychiatric input is invaluable. Partly driven by this close team working and partly based on the early history of DBS for psychiatric disorders, there is increasing interest in re-exploring the potential of neurosurgery to treat patients with psychiatric disease, such as depression and obsessive–compulsive disorder. Although the clinical experience and evidence with DBS in this group of patients are steadily increasing, many questions remain unanswered. Yet, the characteristics of optimal surgical candidates, the best choice of DBS target, the most effective stimulating parameters and the extent of postoperative improvement are not clear for most psychiatric conditions. Further research is therefore required to define how DBS can be best utilised to improve the quality of life of patients with psychiatric disease.

  • Deep Brain Stimulation
  • Neurology
  • Psychiatry

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