Der Nervenarzt
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Deep brain stimulation (DBS) is a safe and successful therapeutic option for patients with dystonia and tremor syndrome who do not respond sufficiently to conservative therapies. The most common target of DBS in patients with dystonia is the internal region of the globus pallidus (GPI). DBS of the GPI leads to long-lasting and remarkable improvement of dystonic movements in about 80% of patients. ⋯ Controlled studies and data on DBS in MS tremor are lacking and data are sparse and heterogeneous. Therefore, VIM-DBS in MS tremor patients has to be evaluated individually with caution. In summary patients with tremor syndromes as well as dystonia who cannot be adequately controlled with conservative therapy are good candidates for deep brain stimulation, a therapeutic option with moderate complications and risks and very good outcome for most patients.
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Deep brain stimulation (DBS) is an important component of the therapy of movement disorders and has almost completely replaced high-frequency coagulation of brain tissue in stereotactic neurosurgery. Despite the functional efficacy of DBS, which in parts is documented on the highest evidence level, the underlying mechanisms are still not completely understood. ⋯ The introduction of technical standards, such as the integration of high resolution MRI into computer-assisted treatment planning, in combination with special treatment planning software have contributed significantly to the reduction of severe surgical complications (frequency of intracranial hemorrhaging 1-3%) in recent years. Future developments will address the modification of hardware components of the stimulation system, the evaluation of new brain target areas, the simultaneous stimulation of different brain areas and the assessment of different stimulation paradigms (high-frequency vs low-frequency DBS).
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Deep brain stimulation at high frequencies has emerged as a powerful therapeutic strategy in the treatment of basal ganglia-related movement disorders. Attempts have also been made to establish this for the treatment of therapy-resistant psychiatric disorders. ⋯ Their detailed description, however, is essential for promoting the extended application of high frequency stimulation as a therapeutic alternative and may simultaneously allow conclusions to be drawn on the pathophysiological mechanisms underlying the diseases benefiting from deep brain stimulation. This review demonstrates how animal models contribute to i) further understand the mechanisms underlying deep brain stimulation at high frequencies and ii) promote the establishment of high frequency stimulation for the treatment of therapy-resistant psychiatric disorders.
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Deep brain stimulation (DBS) is an effective neurosurgical therapy for treatment of motor symptoms in Parkinson's disease (PD). DBS of the subthalamic nucleus (STN-DBS) leads to a significant reduction of hypokinetic and hyperkinetic symptoms and improvement in quality of life. ⋯ Future studies will prospectively compare the clinical effects of STN and pallidal DBS. Alternative targets for treatment of PD have to be considered including the pedunculopontine nucleus, thalamic CM/Pf complex and zona incerta.
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Although instances of amok are very rare, they have captured media and political attention following several occurrences in German schools. Mental health professionals are increasingly faced with threat assessment in order to help prevent such tragedies. Since the base rate of amok is low and current risk assessment lacks empirical foundations, the likelihood of false-positive results is high. ⋯ The focus should not be risk assessment but risk management since most of the mass murderers are in need of some type of psychiatric intervention prior to the massacre. In contrast, compulsory admission and involuntary treatment are only justified if the threats occur in the context of a diagnosed mental disorder. Prospective research approaches that integrate psychopathological and neurobiological methods are urgently needed.