title: Deep brain stimulation: a return journey from psychiatry to neurology.
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.
authors.affiliation: Department of Neurosurgery, King's College Hospital, Denmark Hill, London SE5 9RS, UK. k.ashkan@nhs.net
authors.forename: Keyoumars
authors.initials: K
authors.lastname: Ashkan
authors.forename: Paul
authors.initials: P
authors.lastname: Shotbolt
authors.forename: Anthony S
authors.initials: AS
authors.lastname: David
authors.forename: Michael
authors.initials: M
authors.lastname: Samuel
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000379:methods / Q000639:trends; D004421:Dystonia / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D009069:Movement Disorders / Q000453:epidemiology / Q000628:therapy*; D009462:Neurology / Q000379:methods / Q000639:trends; D019635:Neurosurgical Procedures; D010300:Parkinson Disease / Q000453:epidemiology / Q000628:therapy*; D018579:Patient Selection; D011570:Psychiatry / Q000379:methods / Q000639:trends; D011788:Quality of Life; D018570:Risk Assessment; D005879:Tourette Syndrome / Q000453:epidemiology / Q000628:therapy*; D006113:United Kingdom / Q000453:epidemiology
keywords: Deep Brain Stimulation; Neurology; Psychiatry