Deep Brain Stimulation for Post-Traumatic Stress Disorder [Neurosurgery Wiki]

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====== Deep Brain Stimulation for Post-Traumatic Stress Disorder ======

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In [[2018]] the application of [[DBS]] for [[Post-Traumatic Stress Disorder]] was still strictly investigational and animal models suggested that [[stimulation]] of the [[amygdala]], [[ventral striatum]], [[hippocampus]], and [[prefrontal]] cortex may be effective in [[fear extinction]] and [[anxiety]]-like behavior
((Lavano A, Guzzi G, Della Torre A, Lavano SM, Tiriolo R, Volpentesta G. DBS in Treatment of Post-Traumatic Stress Disorder. Brain Sci. 2018 Jan 20;8(1):18. doi: 10.3390/brainsci8010018. PMID: 29361705; PMCID: PMC5789349.)).
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[[Neuroimaging]], preclinical, and preliminary clinical data suggested that the use of DBS for the treatment of PTSD may be practical 
((Reznikov R, Hamani C. Posttraumatic Stress Disorder: Perspectives for the Use 
of Deep Brain Stimulation. Neuromodulation. 2016 Dec 19. doi: 10.1111/ner.12551. 
[Epub ahead of print] Review. PubMed PMID: 27992092.
)).
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PTSD is the only potential clinical indication for DBS that shows extensive animal research prior to human applications. Nevertheless, DBS for PTSD remains highly investigational. Despite several years of government funding of DBS research in view of treating severe PTSD in combat veterans, ethical dilemmas, recruitment difficulties, and issues related to using of DBS in such a complex and heterogenous disorder remain prevalent
((Meeres J, Hariz M. Deep Brain Stimulation for Post-Traumatic Stress Disorder: A Review of the Experimental and Clinical Literature. Stereotact Funct Neurosurg. 2022 Jan 3:1-13. doi: 10.1159/000521130. Epub ahead of print. PMID: 34979516.)).
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Hamani et al. treated four [[posttraumatic stress disorder]] (PTSD) patients with [[DBS]] delivered to the subgenual [[cingulum]] and the [[uncinate fasciculus]]. In addition to validated clinical scales, patients underwent [[neuroimaging]] studies and psychophysiological assessments of fear conditioning, extinction, and recall. They show that the procedure is safe and potentially effective (55% reduction in Clinical Administered PTSD Scale scores). Posttreatment imaging data revealed metabolic activity changes in PTSD neurocircuits. During psychophysiological assessments, patients with PTSD had higher skin conductance responses when tested for recall compared to healthy controls. After DBS, this objectively measured variable was significantly reduced. Last, they found that a ratio between recall of extinguished and nonextinguished conditioned responses had a strong correlation with [[clinical outcome]]s. As this variable was recorded at baseline, it may comprise a potential [[biomarker]] of treatment response
((Hamani C, Davidson B, Corchs F, Abrahao A, Nestor SM, Rabin JS, Nyman AJ, Phung L, Goubran M, Levitt A, Talakoub O, Giacobbe P, Lipsman N. Deep brain stimulation of the subgenual cingulum and uncinate fasciculus for the treatment of posttraumatic stress disorder. Sci Adv. 2022 Dec 2;8(48):eadc9970. doi: 10.1126/sciadv.adc9970. Epub 2022 Dec 2. PMID: 36459550.)).
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===== Amygdala Deep Brain Stimulation for Post-Traumatic Stress Disorder =====

[[Amygdala Deep Brain Stimulation for Post-Traumatic Stress Disorder]].