Deep brain stimulation for patients with treatment-resistant schizophrenia: a multicentre prospective study
Deep brain stimulation (DBS) in which high frequency electrical pulses are delivered to specific brain areas through implanted electrodes, has an established place in neurological disorders. It has also demonstrated encouraging results in refractory forms of obsessive-compulsive and depression. Its use in patients with treatment-resistant schizophrenia is of considerable current interest, but evidence is preliminary. The first and so far, the only completed formal trial (N=7), carried out partly by members of the current research group, found preliminary evidence of effectiveness in 3 treatment resistant schizophrenia patients stimulating the nucleus accumbens, a dopamine-rich site of the brain.
The present study aims to further examine the efficacy and safety of DBS in the nucleus accumbens (N=4 patients) and to explore its potential effectiveness in a new site, the ventral tegmental area (N=4), the brain area that gives rise to dopamine projections relevant to schizophrenia. The study will follow the design of our earlier trial: after a 6 month (or longer) open treatment phase, patients with predetermined criteria for improvement will undergo a 12-week crossover phase where the current will be switched off for half the time under double-blind conditions. Extended post-trial follow-up (12+ months) will monitor long term adverse psychiatric effects.