Target selection for deep brain stimulation in treatment resistant schizophrenia
Por:
Corripio, I, Roldan, A, McKenna, P, Sarro, S, Alonso-Solis, A, Salgado, L, Alvarez, E, Molet, J, Pomarol-Clotet, E, Portella, M
Publicada:
10 ene 2022
Ahead of Print:
1 sep 2021
Resumen:
The use of deep brain stimulation (DBS) in treatment resistant patients with schizophrenia is of considerable current interest, but where to site the electrodes is challenging. This article reviews rationales for electrode placement in schizophrenia based on evidence for localized brain abnormality in the disorder and the targets that have been proposed and employed to date. The nucleus accumbens and the subgenual anterior cingulate cortex are of interest on the grounds that they are sites of potential pathologically increased brain activity in schizo-phrenia and so susceptible to the local inhibitory effects of DBS; both sites have been employed in trials of DBS in schizophrenia. Based on other lines of reasoning, the ventral tegmental area, the substantia nigra pars reticulata and the habenula have also been proposed and in some cases employed. The dorsolateral prefrontal cortex has not been suggested, probably reflecting evidence that it is underactive rather than overactive in schizophrenia. The hippocampus is also of theoretical interest but there is no clear functional imaging evidence that it shows overactivity in schizophrenia. On current evidence, the nucleus accumbens may represent the strongest candi-date for DBS electrode placement in schizophrenia, with the substantia nigra pars reticulata also showing promise in a single case report; the ventral tegmental area is also of potential interest, though it remains untried.
Filiaciones:
Corripio, I:
Univ Autonoma Barcelona, Psychiat Dept, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Roldan, A:
Univ Autonoma Barcelona, Psychiat Dept, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
McKenna, P:
FIDMAG Germans Hosp, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Sarro, S:
FIDMAG Germans Hosp, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Alonso-Solis, A:
Univ Autonoma Barcelona, Psychiat Dept, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Salgado, L:
Univ Autonoma Barcelona, Neurosurg Dept, Hosp Santa Creu & St Pau, Barcelona, Spain
Alvarez, E:
Univ Autonoma Barcelona, Psychiat Dept, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Molet, J:
Univ Autonoma Barcelona, Neurosurg Dept, Hosp Santa Creu & St Pau, Barcelona, Spain
Pomarol-Clotet, E:
FIDMAG Germans Hosp, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
Portella, M:
Univ Autonoma Barcelona, Psychiat Dept, Hosp Santa Creu & St Pau, Biomed Res Inst St Pau IIB St Pau, Barcelona, Spain
Ctr Invest Biomed Red Salud Mental CIBERSAM, Madrid, Spain
|