Deep Brain Stimulation for Schizophrenia?

three domains of schizophrenia

In short, a recent article proposed to do deep brain stimulation for schizophenia. Schizophrenia has positive-, negative- and cognitive symptoms (see the figure above). The authors propose the DBS for positive symptoms. Their approach is based on current models of the neurocircuitry of psychosis .

They hypothesize:

that chronic, high frequency electrical stimulation (HFS) of the hippocampus or the nucleus accumbens (NAc), through stabilization of dopamine (DA) release in the striatum, may improve positive symptoms in patients with schizophrenia.

I checked but no one is doing a trial with DBS and schizophrenia yet.

Their hypothesis is based on the assumption that hippocampal hyperactivity early in the course of the illness leads to excessive dopamine release and the appearance of positive symptoms. Stimulation of the hippocampus might slow down this hyper stimulation as in a rodent model of schizophrenia.

The nucleus accumbens plays an important part in the dopamine release in response to hippocampal activation, stimulation of the nucleus accumbens might interrupt this circuit and stabilize dopamine release.

Nu Accumbens and hippocampus

In their article they also propose other possible targets but the above mentioned are their favorites. They conclude with the suggestion that their hypotheses needs to be verified with neuroimaging and animal models.

Finally, our claim that stabilization of DA levels is the most likely explanation for the clinical effects of NAc stimulation needs to be evaluated experimentally. A variety of human, nonhuman primate, and rodent studies using in vivo microdialysis, micro-PET, and other techniques could be designed for this purpose.

What do you think will there be a place for deep brain stimulation for schizophrenia?

In the accompanying comment questions are raised whether the dopamine model is not to simple. Other neurotransmitters also play a role in schizophrenia. Moreover, stimulating the hippocampus might also affect cognition and emotions. The chief complaint being the wide range of phenotypes with schizophrenia. We don’t even know whether schizophrenia is just one disease or the face of many. And what about negative symptoms. They won’t be lessened according to this hypotheses. Nevertheless an interesting read.
Mikell, C., McKhann, G., Segal, S., McGovern, R., Wallenstein, M., & Moore, H. (2009). The Hippocampus and Nucleus Accumbens as Potential Therapeutic Targets for Neurosurgical Intervention in Schizophrenia Stereotactic and Functional Neurosurgery, 87 (4), 256-265 DOI: 10.1159/000225979

Bakay, R. (2009). Deep Brain Stimulation for Schizophrenia Stereotactic and Functional Neurosurgery, 87 (4), 266-266 DOI: 10.1159/000225980