Deep brain stimulation in neuropsychiatric disorders: A systematic review
Bibliographic record
Abstract
Deep brain stimulation (DBS) is a neurosurgical technique that modulates neural circuits through electrical impulses. Initially developed for motor disorders such as Parkinson's disease, its use has expanded to neuropsychiatric conditions, including treatment-resistant schizophrenia, obsessive-compulsive disorder (OCD), and chronic anorexia nervosa, with promising results. However, challenges remain regarding treatment personalization, identification of anatomical targets, and understanding its mechanisms of action. To assess the effectiveness, safety, and technical factors associated with DBS in neuropsychiatric disorders through a systematic review of the available scientific literature. A systematic review was conducted following PRISMA guidelines. Controlled clinical trials, observational studies, and case series with ≥ 10 participants were included, covering neuropsychiatric conditions such as OCD, treatment-resistant schizophrenia, and chronic anorexia nervosa. The primary outcomes were changes in clinical scales (e.g., PANSS, Y-BOCS) and adverse events, analyzed using critical appraisal tools such as RoB2 and the Newcastle-Ottawa scale. Out of 3351 initial records, 11 studies with 235 participants were included. Significant improvements were observed in specific symptoms: a 40% reduction in motor tics (p < 0.001) in Tourette syndrome, and a 10% increase in body mass index (p = 0.02) in anorexia nervosa. However, effects on Alzheimer's disease were heterogeneous, showing cognitive decline in patients < 65 years (p = 0.006). Adverse events included mild neuropsychological impairment and severe perioperative complications in isolated cases. DBS proves effective in refractory neuropsychiatric disorders, modulating specific symptoms and improving quality of life. Methodological limitations persist in the literature, such as small sample sizes and heterogeneity in stimulation parameters. The need for multicenter studies and biomarkers to predict therapeutic responses is emphasized. La estimulación cerebral profunda (ECP) es una técnica neuroquirúrgica que modula los circuitos neuronales mediante impulsos eléctricos. Aunque originalmente fue desarrollada para tratar trastornos del movimiento como la enfermedad de Parkinson, posteriormente se ha utilizado en enfermedades neuropsiquiátricas graves, incluyendo la esquizofrenia resistente al tratamiento, el trastorno obsesivo-compulsivo (TOC) y la anorexia nerviosa crónica. A pesar de los resultados clínicos prometedores, persisten desafíos relacionados con la selección de pacientes, la identificación de los mejores blancos de estimulación y la comprensión de los mecanismos de acción. Se llevó a cabo una revisión sistemática siguiendo las directrices PRISMA, que incluyó ensayos clínicos controlados, estudios observacionales y series de casos con al menos 10 participantes. La revisión se centró en el uso de la ECP en el TOC, la esquizofrenia resistente al tratamiento y la anorexia nerviosa crónica. El resultado primario fue la modulación de los síntomas evaluada mediante escalas clínicas (p. ej., PANSS, Y-BOCS) y el reporte de eventos adversos. Se incluyeron un total de 11 estudios, con 235 pacientes, seleccionados de entre 3351 registros iniciales. La ECP mostró mejoras significativas en los síntomas, incluyendo una reducción del 40% en los tics motores en el síndrome de Tourette (p < 0.001) y un aumento del 10% en el índice de masa corporal en la anorexia nerviosa (p = 0.02). Sin embargo, los resultados en la enfermedad de Alzheimer fueron menos consistentes, observándose deterioro cognitivo solo en pacientes menores de 65 años (p = 0.006). Los efectos adversos variaron desde síntomas cognitivos leves hasta complicaciones quirúrgicas graves, aunque poco frecuentes. La ECP puede ser una opción terapéutica eficaz para algunos trastornos neuropsiquiátricos refractarios, al proporcionar alivio sintomático y mejora en la calidad de vida. Sin embargo, se requieren más estudios multicéntricos, comparativos y estandarizados con muestras más amplias para determinar biomarcadores predictivos, la seguridad y la eficacia a largo plazo.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.006 |
| Bibliometrics | 0.007 | 0.008 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".