Deep brain stimulation for treatment of refractory depression.

ABSTRACT: Deep brain stimulation is the stereotaxic placement of unilateral or bilateral electrodes connected to a permanently implanted neurostimulator. Although the mode of action is unknown, the hypothesis is that chronic high frequency (130–185 Hz) stimulation reduces neural transmission through inactivation of voltage-dependent ion channels. 1 Deep brain stimulation is widely used for severe tremor in Parkinson's disease, an indication in which it is highly effective in reducing the severe motor complications (mainly tremor) associated with the disease, whereas the overall process of degeneration cannot be slowed down, as shown in a recent study by R Hilker and colleagues. 2 Further clinical indications include essential tremor and primary dystonia. Use of the technique is also being investigated in treatment-resistant cluster headache (stimulation of the ipsilateral ventro posterior hypothalamus), 3 treatment-refractory obsessive-compulsive disorder (stimulation of the anterior limb of the capsula interna), and treatment-refractory major depression (stimulation of a subgenual cingulate region and other regions)