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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

Deep brain stimulation for psychiatric disorders – long-term surgical management

Chirurgisches Langzeit-Management von Patienten mit Tiefer Hirnstimulation zur Behandlung psychiatrischer Erkrankungen

Meeting Abstract

  • presenting/speaker Martin Jakobs - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • David Hernįn Aguirre-Padilla - University of Chile, Department of Neurology and Neurosurgery, Santiago de Chile, Chile
  • Peter Giacobbe - Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Kanada
  • Andreas W. Unterberg - Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
  • Andres M. Lozano - University Health Network, Toronto, Division of Neurosurgery, Toronto, Kanada

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV059

doi: 10.3205/21dgnc060, urn:nbn:de:0183-21dgnc0608

Published: June 4, 2021

© 2021 Jakobs et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Deep Brain Stimulation (DBS) has implemented itself as a hallmark in movement disorder therapy and has been explored for psychiatric disorders in clinical trials as an adjunct treatment. Data on how to surgically manage these patients long after the clinical trial has ended is currently lacking.

Methods: A single center database analysis was performed to identify all cases of DBS for psychiatric indications. Epidemiologic data, number and type of follow-up surgeries after initial implantation, rate of complications, success in long-term therapy and documented stimulation parameters were analyzed.

Results: Over 17 years n=103 patients were implanted with a DBS system for a psychiatric indication (excluding dementias) with a mean follow-up of 106 months. Mean age was 43.1 years with two thirds being female. Indications were major depression (n=66), bipolar disorder (n=6), OCD (n=6), anorexia nervosa (n=22) and Tourette’s syndrome (n=3). The predominant target structure was the subgenual cingulate gyrus (CG25, 91% for depression, bipolar disorder and anorexia. The interthalamic peduncle (ITP, 6%) and the centromedian-parafascicular nucleus of the thalamus (CM-Pf, 3%). 48.5% of all patients still had an active DBS system with a mean follow-up of 94 months at the time of the study. 21.4% of patients had the system explanted with lack of efficacy being the most common one (77% of explants). IPG replacements were the most common scheduled surgery with an average of 2.3 replacements per patient. IPGs lasted for an average of 24.0 months with average stimulation parameters of 130Hz, 85µs and 5.3V. N=42 patients were switched to a rechargeable IPG with 24% being switched back to a non-rechargeable IPG later on. 37% of patients had unscheduled surgeries for wound-related complications (15.5% of patients), hardware related issues (10.6%) or suboptimal electrode placement (1.0%).

Conclusion: Patients with DBS for psychiatric disorders represent a separate entity compared to movement disorder patients. The rate of explants and unscheduled surgeries is higher. High stimulation parameters demand frequent IPG replacements generating a considerable rate of wound-related complications. Strategies to reduce the number of IPG replacements (optimization of stimulation parameters, use of rechargeable IPGs) could help to increase the rate of long-term responders in the future. When conceiving trials, strategies on how to enable long-term therapy for these patients should be considered.