Is Deep Brain Stimulation a Promising Treatment for Schizophrenia?

Patients with treatment-resistant schizophrenia may benefit from treatment with deep brain stimulation, according to preliminary results of a pilot study.

Deep brain stimulation has been investigated as a possible treatment for other types of psychiatric disorders, including depression and neurodegenerative diseases. The study’s authors hypothesized that patients with refractory schizophrenia may also improve after deep brain stimulation.

To test the hypothesis, lead author Laura Salgado, MD, and her colleagues, conducted a prospective, randomized, double-blind clinical trial. Patients with treatment-resistant, chronic, paranoid schizophrenia were randomized to receive deep brain stimulation of either the nucleus accumbens or subgenual area. The two target areas were based on different physiological hypotheses, the study’s authors noted.
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Once patients were clinically stabilized, the researchers performed a cross-type sequence randomization (generator on/off) every 6 months. The study is ongoing, but the researchers presented results from surgeries that began in December 2014. Thus far, 7 patients with treatment-resistant schizophrenia (57% women) underwent surgery, and patients had a mean age of 42.4 years. In 4 of the patients, the nucleus accumbens was targeted, and in 3 patients the subgenual area was targeted.

Surgical complications occurred in 1 patient, and 2 of the patients had worsening symptoms after the generator was switched off. 

In the other patients, there were “remarkable changes,” the study’s authors wrote. These changes included progressive improvement of social isolation symptoms and auditory hallucinations in all patients. The average improvement in the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) score, the primary outcome measure, was 37.5%.

The study is anticipated to be completed in 2017, after recruitment of additional cases. At this time, the study is under analysis. According to the researchers, preliminary results suggest that deep brain stimulation can effectively treat refractory schizophrenia, but the study must be completed and additional, multicenter trials should be conducted to more definitely determine the effectiveness of the treatment.

—Lauren LeBano

Reference

Salgado S, Roldán A, Rodriguez R. A pilot study of deep brain stimulation in treatment resistant schizophrenia. Abstract 800. American Association of Neurological Surgeons Meeting. April 25, 2017.