Deep brain stimulation for patients with treatment-resistant schizophrenia and bipolar disorder

2023-07-13 10:30:47

The deep brain stimulation It is a neurosurgical procedure that involves the placement of a medical device called a neurostimulator, which sends electrical impulses to specific areas of the brain, through electrodes.

Worldwide, more than 160,000 patients have been treated with this technique for different brain pathologies, mainly neurological disorders such as movement disorders or epilepsy.

This pilot study has evaluated the effects of deep brain stimulation as a therapeutic strategy

“In patients with depression or obsessive-compulsive disorders, who do not respond to treatment, encouraging results have also been obtained,” he explains. Miquel Bioqueresearcher of the IDIBAPS Schizophrenia group, directed by Miguel Bernardo.

Since around 30% of people with schizophrenia and 15% of people with bipolar disorder do not respond adequately to drugs either, the Clínic Barcelona-IDIBAPS psychiatry team has carried out a pilot study to assess the effects of Deep brain stimulation as a therapeutic strategy.

In the work, published by the Spanish Journal of Psychiatry and Mental Healthfour patients with schizophrenia and bipolar disorder resistant to treatment have participated.

“The electrodes were placed in different areas of the brain depending on the symptoms, affective or psychotic, that each case presented and its evolution. Likewise, the characteristics of the electrical stimulus were also adapted to each patient”, says the co-author Eduard Vietahead of the IDIBAPS Bipolar and Depressive Disorders group at the Clínic Barcelona.

Mobile monitoring

In addition to intensive psychiatric and surgical follow-up for one year to assess the efficacy and safety of the technique, the researchers monitored the patients through a mobile application and a portable device. The app collected mood symptoms, while the device recorded physical activity and sleep patterns.

“After this time, we observed a remarkable and stable therapeutic response in two of the four patients. The third showed relevant relief of clinical symptoms. On the other hand, the room did not respond significantly”, details Bioque.

With deep brain stimulation we observed a remarkable therapeutic response in two patients, relief of clinical symptoms in a third, and a fourth non-responder.

Miquel Bioque (IDIBAPS)

“Therefore,” he adds, “it was possible to interrupt the maintenance electroconvulsive therapy sessions in the three responders. The good results also made it possible to reduce part of the pharmacological treatment”.

Image of the location of the deep brain stimulation leads (visible as white marks) and the planned surgical trajectories (green right hemisphere, purple left hemisphere) in the nucleus accumbens of patient N2. / Barcelona Clinic-IDIBAPS

For the researchers, the finding constitutes a initial evidence that the technique may be an effective alternative and safe to treat complex and treatment-resistant forms of schizophrenia and bipolar disorder.

“This opens the door and gives hope for a particularly complex group of patients,” says Vieta. However, the authors acknowledge that the study has some limitations, such as the small number of patients included, the different diagnoses of these or the short duration of follow-up, for which reason the investigations will continue.

Reference:

J. Miquel Bioque et al. “Deep brain stimulation and digital monitoring for patients with treatment-resistant schizophrenia and bipolar disorder: a case series”. Journal of Psychiatry and Mental Health – Journal of Psychiatry and Mental Health2023.

This work has received funding from the bequest that the Pons-Bertran family gave to the Psychiatry Service of the Clínic Barcelona. Thanks to funds from the Marathon Foundation and the Carlos III Health Institute, the data will be expanded.

Fuente: Clinic Barcelona – IDIBAPS

Rights: Creative Commons.