Medical Student University of California at Irvine Irvine, California, United States
Introduction: Despite its relatively low prevalence, schizophrenia can greatly impair individuals' quality of life. Alternatively, patients have difficulty with medication maintenance, and pharmaceutical management may only cover some of the symptoms. This review investigated how neurosurgical deep brain stimulation can mitigate treatment-refractory schizophrenia. Pathophysiological data and ongoing clinical trials were reviewed to suggest which targets hold promise for neurosurgical efficacy.
Methods: A systematic review of the literature was conducted via an electronic search of the PubMed, SCOPUS, and Web of Science databases. Included papers were human studies of neurosurgical interventions for schizophrenia conducted between 2012-2022. An electronic search of clinicaltrials.gov and the International Clinical Trials Registry Platform was conducted using to find ongoing clinical trials.
Results: Eight human studies were included in the review. Five utilized DBS on the nucleus accumbens, subgenual anterior cingulate cortex, habenula, and substantial nigra pars reticulata. The remaining three human studies included subcaudate tractotomies and anterior capsulotomies. Overall, human studies demonstrated long-term reduction in PANSS scores in many participants, having a few surgical and psychological side effects for patients.
Conclusion : As the precise mechanism of schizophrenia is not yet elucidated, there are several potential therapeutic targets for neurosurgical intervention for schizophrenia. Recent efforts identified in this review have revealed possible therapeutic effects of DBS for schizophrenia in the hippocampus, subgenual anterior cingulate cortex, habenula, substantia nigra pars reticulata, and medial frontal cortex. In addition, data also suggest that neuroablation in the subcaudate tract and anterior capsulotomy may be beneficial for some patients. We recommend further exploration of neuromodulation in schizophrenia, coupled with rigorous standards for treatment-refractory schizophrenia being met in patients before these procedures are considered.
