Charting the road forward in psychiatric neurosurgery: proceedings of the 2016 American Society for Stereotactic and Functional Neurosurgery workshop on neuromodulation for psychiatric disorders

• Type of Material: Article
• Authors: Ausaf A. Bari, University of California Los Angeles; Charles B. Mikell, Stony Brook University Hospital; Aviva Abosch, University of Colorado; Sharona Ben-Haim, Univ Calif San Diego Hlth; Robert J. Buchanan, Seton Brain & Spine Inst; Allen W. Burton, St Jude Abbott; Stephen Carcieri, Boston Scientific Corporation; G. Rees Cosgrove, Brigham & Womens Hospital; Pierre-Francois D'Haese, Vanderbilt University; Zafiris Jeffrey Daskalakis, University of Toronto; Emad N. Eskandar, Albert Einstein College of Medicine; Jason L. Gerrard, Yale University; Wayne K. Goodman, Baylor College of Medicine; Benjamin David Greenberg, Brown University; Robert Gross, Emory University; Clement Hamani, University of Toronto; Zelma H. T. Kiss, University of Calgary; Peter Konrad, Vanderbilt University; Brian H. Kopell, Mt Sinai Hospital; Lothar Krinke, Medtron Neuromodulation; Jean-Philippe Langevin, University of California Los Angeles; Andres M. Lozano, University of Toronto; Donald Malone, Cleveland Clinic; Helen Mayberg, Emory University; Jonathan P. Miller, Case Western Reserve University; Parag G. Patil, University of Michigan; DeLea Peichel, St Jude Abbott; Erika A. Petersen, University of Arkansas Medical Sciences; Ali R. Rezai, Ohio State University; R. Mark Richardson, University of Pittsburgh; Patricio Riva Posse, Emory University; Tejas Sankar, University of Alberta; Jason M. Schwalb, Henry Ford Health System; Helen Blair Simpson, Columbia University; Konstantin Slavin, University of Illinois; Paul H. Stypulkowski, Medtron Neuromodulation; Tor Tosteson, Dartmouth College; Peter Warnke, University of Chicago; Jon Willie, Emory University; Kareem A. Zaghloul, National Institute of Neurological Disorders and Stroke; Joseph S. Neimat, University of Louisville; Nader Pouratian, University of California Los Angeles; Sameer A. Sheth, Baylor College of Medicine
• Language: English
• Date: 2018-08-01
• Publisher: BMJ Publishing Group
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/jnnp-2017-317082
• Title of Journal or Parent Work: Journal of Neurology, Neurosurgery & Psychiatry
• Volume: 89
• Issue: 8
• Start Page: 886
• End Page: 896
• Grant/Funding Information: This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
• Keywords: Life Sciences & Biomedicine; Basolateral amygdala; Neurosciences & Neurology; Treatment resistant depression; Electrical stimulation; Science & Technology; Ventral capsule; Subcallosal cingulate gyrus; Clinical Neurology; Obsessive compulsive disorder; Deep brain stimulation; Focused ultrasound; Psychiatry; Surgery
• Research Categories: Psychology, Psychobiology; Health Sciences, Medicine and Surgery; Biology, Neuroscience

Abstract

Objective Refractory psychiatric disease is a major cause of morbidity and mortality worldwide, and there is a great need for new treatments. In the last decade, investigators piloted novel deep brain stimulation (DBS)-based therapies for depression and obsessive-compulsive disorder (OCD). Results from recent pivotal trials of these therapies, however, did not demonstrate the degree of efficacy expected from previous smaller trials. To discuss next steps, neurosurgeons, neurologists, psychiatrists and representatives from industry convened a workshop sponsored by the American Society for Stereotactic and Functional Neurosurgery in Chicago, Illinois, in June of 2016. Design Here we summarise the proceedings of the workshop. Participants discussed a number of issues of importance to the community. First, we discussed how to interpret results from the recent pivotal trials of DBS for OCD and depression. We then reviewed what can be learnt from lesions and closed-loop neurostimulation. Subsequently, representatives from the National Institutes of Health, the Food and Drug Administration and industry discussed their views on neuromodulation for psychiatric disorders. In particular, these third parties discussed their criteria for moving forward with new trials. Finally, we discussed the best way of confirming safety and efficacy of these therapies, including registries and clinical trial design. We close by discussing next steps in the journey to new neuromodulatory therapies for these devastating illnesses. Conclusion Interest and motivation remain strong for deep brain stimulation for psychiatric disease. Progress will require coordinated efforts by all stakeholders.