RESUMEN
Current progress of basic and clinical science creates background for new therapeutic appliances of brain stimulation methods in disorders of central nervous system. This review describes present state of knowledge regarding practical aspects of one of those methods - transcranial magnetic stimulation, TMS. The review was based on contemporary literature on use of transcranial magnetic stimulation in various diseases, particularly including present recommendations and guidelines as well as systematic reviews, published after year 2000. TMS is a quite novel, non-invasive, well tolerated treatment method with alow amount of transient adverse effects and complications. Development of new therapeutic protocols makes it possible to introduce this procedure in new groups of patients, including a wide range of mental disorders such as depression, bipolar disorder, schizophrenia, also cognitive function disorders and posttraumatic stress disorder. In Poland it is still hardly available, though more and more clinical centers start to perform this kind of therapy, providing proper equipment and trained personnel.
Asunto(s)
Trastorno Bipolar , Trastornos del Conocimiento , Esquizofrenia , Encéfalo , Humanos , Esquizofrenia/terapia , Estimulación Magnética TranscranealRESUMEN
Deep brain stimulation (DBS) is a treatment method that is currently getting more and more attention from psychiatrists. It has proven to be efficacious and safe in the treatment of neurological disorders, mainly Parkinson's disease (PD), dystonia and essential tremor. DBS has very often contributed to successful treatment in cases that had proved resistant to all other methods of treatment. Nowadays treatment-resistant obsessive-compulsive disorder (OCD) is the main psychiatric indication for DBS. Many studies have focused on assessing the efficacy and safety of this method in different mental disorders, including depressive disorders, Alzheimer's disease, anorexia nervosa, Tourette syndrome, substance addiction or aggressive behaviors. Single cases of successful treatment in bipolar disorder, schizophrenia and post-traumatic stress disorder have also emerged in recent years. In this review the current state of knowledge on the applicability of DBS in psychiatry is presented, based on the available systematic reviews, clinical trials and case studies, as well as on neurophysiological and neuroimaging data.
Asunto(s)
Encéfalo/fisiopatología , Estimulación Encefálica Profunda/métodos , Trastornos Mentales/terapia , Neuropsiquiatría/normas , Anorexia Nerviosa/terapia , Trastorno Depresivo Mayor/terapia , Humanos , Trastorno Obsesivo Compulsivo/terapia , Esquizofrenia/terapia , Trastornos por Estrés Postraumático/terapia , Trastornos Relacionados con Sustancias/terapia , Síndrome de Tourette/terapia , Resultado del TratamientoRESUMEN
Obsessive-compulsive disorder (OCD) occurs in 2-3% of the general population. Due to its chronicity and high resistance to standard treatment, alternative clinical management based on neuroscientific findings has been sought. Deep brain stimulation (DBS) is a modern and dynamic approach in the treatment of OCD giving hope to patients who are resistant to current pharmacotherapy and psychotherapy based treatments. This paper presents two cases of patients diagnosed with refractory OCD who received DBS therapy with concurrent pharmacotherapy and cognitive behavioral psychotherapy (CBT). Both patients underwent a neurosurgical procedure to implant electrodes into the anterior limb of the internal capsule (ALIC) and nucleus accumbens (NAc). Before and after the start of neurostimulation, patients underwent a clinical evaluation which consisted of a psychiatric examination and psychometric measurements (Y-BOCS, HAMA, HDRS, GAF, SOFAS). During the follow-up period, a blind attempt to switch off the neurostimulation was made. During the 6-month follow-up period, a significant reduction in the obsessive-compulsive, depressive and anxiety symptoms was achieved as well as an improvement in global patient functioning. The tolerance of DBS was found to be very good and no significant side effects were observed. The obtained results provide the basis for the implementation of this method in patients with OCD who are resistant to current treatment.