脳障害と治療

概要

Deep Brain Stimulation for Treatment-Resistant Depression: Review of the Literature

Angelo Lavano*, Attilio Della Torre, Giorgio Volpentesta, Giusy Guzzi, Marisa De Rose and Mary Romano

Chronic Major depression is one of the most debilitating psychiatric disorders ; 8-13% of patients are treatment resistant. DBS has been applied to the following targets: Subcallosal cingulate gyrus (Brodmann 25a), Ventral Capsule and Ventral Striatum (VC/VS), Nucleus Accumbens (NA), Inferior thalamic Peduncle (ITP) Rostral Cingulate Cortex. In the contrary to neurological diseases, for major depression there is not a single pathological target structure; several brain structures presumably play different roles in the development as well as in the maintenance of symptoms; some targets are in close anatomical or functional relationship (neural networks) and an overlap of effect is plausible; different target might manipulate the pathological network at different nodes. This overview summarizes research on the mechanisms of brain networks with respect to psychiatric diseases and highlights the role of the reward system in DBS for patients with treatment-resistant depression.