DBS in psychiatry and the pendulum of history

Abstract

Recent published statements on Deep brain stimulationdeep brain stimulation (DBS) by psychiatrists and ethicists claim that DBS was developed first for movement disorders and is now applied in psychiatry; that it was the behavioural and psychiatric side-effects of DBS in subthalamic nucleus (STN) in Parkinsonian patients that prompted investigation of DBS in psychiatry; and that neurosurgeons should not act alone in this field, but should be within multidisciplinary teams in order not to repeat abuses of the past. The present author conducted a review of old literature since the birth of human stereotactic neurosurgery in 1947 and established the following: (1) The first applications of DBS in the early 1950s were in the field of psychiatry, and promoted mainly by neurologists and psychiatrists without involvement of neurosurgeons. (2) Some of these old psychiatric applications of DBS were found to be dubious and precarious even by yesterday’s ethical standards. (3) Modern DBS for psychiatric illness started in 1999 on the initiative of neurosurgeons who had involved from the beginning psychiatrists, and it had nothing to do with non-motor side-effects of STN DBS. (4) A recent consensus meeting on psychiatric DBS insisted in its guidelines on multidisciplinarity and included 30 panelists none of whom a neurosurgeon.