Clinical Science Research
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Introduction: Effective treatment of medically-refractory epilepsy remains a formidable challenge in many patients. The SANTE trial (2010) led to the FDA approval of deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) for the treatment of medically-refractory epilepsy. However, ANT DBS also raised significant mental health concerns. This review will take another look at the psychiatric effects of DBS to more definitively outline the mental health risks and identify additional targets to guide future treatment.
Methods: A search of the clinical literature published between January 1, 1990 and December 31, 2019 was completed. The most relevant papers were reviewed with special focus on psychiatric effects. The references cited in select papers were utilized to obtain additional sources.
Results: DBS targets associated with adverse psychiatric effects included various thalamic nuclei (ANT, STN, VIM), the globus pallidus interna, the internal capsule and the subcallosal cingulate gyrus. Those not associated with a reported decline included the centromedian nucleus of the thalamus, the nucleus accumbens, the hippocampus, the hypothalamus and the cerebellum. Possible improvement in psychiatric health was noted with stimulation of the hippocampus, the centromedian nucleus and the cerebellum.
Conclusion: The results of this review note the probable risk of mental health decline with certain DBS targets. Yet, it also highlights targets with less risk of psychiatric effects, most notably, the hippocampus, the centromedian nucleus and the cerebellum. These results are limited by the number of studies not directly reporting psychiatric effects and small sample sizes. The psychiatric outcomes of DBS in targets not known to be associated with either induction of or exacerbation of psychiatric illness is an area for future research.
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VCU School of Medicine GME Resident and Fellow Research Day Posters