[Deep brain stimulation for addiction, anorexia and compulsion. Rationale, clinical results and ethical implications].
BACKGROUND
As an established treatment for movement disorders, the application of deep brain stimulation (DBS) for psychiatric indications has been investigated for almost 15 years. A CE label (also FDA approval) has recently been obtained for treatment of refractory obsessive-compulsive disorder (OCD).


OBJECTIVE
This article aims at illustrating the current state of DBS in the treatment of refractory OCD. In addition, initial experimental approaches to investigate the potential use of DBS in substance addiction and anorexia nervosa (AN) will also be outlined as both disorders share some common features with OCD.


METHODS
The present review is based on a keyword literature search (PubMed) while taking into account relevant references and own investigations


RESULTS
Although the number of clinical trials for treatment of refractory OCD is limited and sample sizes are small, there is some evidence for a substantial improvement, a so-called full response of OCD symptoms under DBS. However, not all patients benefit from the intervention. Regarding substance addiction and AN, data are scarce and are only indicative of a potential benefit at most.


CONCLUSIONS
Present data regarding the clinical benefits of DBS in OCD are encouraging and open up new avenues for the treatment of therapy refractory patients. However, several aspects, such as mechanisms of action, predictors and long-term side effect profiles, are incomplete or even unknown. In the case of addiction and AN, DBS remains purely experimental, at least for the moment. Hence, clinical trials should remain the gold standard for all three indications.
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Bartsch
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Kuhn
D000856:Anorexia Nervosa / Q000175:diagnosis / Q000628:therapy*; D046690:Deep Brain Stimulation / Q000009:adverse effects / Q000941:ethics* / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D019966:Substance-Related Disorders / Q000628:therapy*; D016896:Treatment Outcome