**13. Summary**

*Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice*

**Obsessive–compulsive disorder** (OCD) is a debilitating psychological condition, which is characterized by obsessions combined with time-consuming and subjectively anxiolytic behaviors. Several targets were proposed for OCD treatment, but STN DBS was found to be the most effective with significant reduction in

Anorexia nervosa is a severe, prevalent, and has one of the highest mortalities among any psychiatric disorder. The limbic and emotional circuits are involved

activating and upholding the disorder. The limited availability of treatment in refractory anorexia nervosa and positive outcomes of DBS in mood-related circuits have led the curiosity for DBS targets availability in anorexia nervosa condition. Several research articles are published on SCC DBS target with significant reduction in depression and anxiety [70]. However, further studies are needed for convincing target for DBS.

For patients with pain, the analysis of DBS outcome is more challenging than in motor movement disorders due to rationality of pain self-assessment. Though nociceptive pain can usually be kept in check with opiate medication, DBS targets in the thalamus or cingulum are considered for patients with severe refractory neuro-

There are a number of side effects via medication that is highly reduced by neuromodulation technique. Seizure frequencies and mortality were decreased, but the results were not evaluated. Successful results of DBS on movement disorder and vagal nerve stimulation for epilepsy [73, 74]. DBS is a best way to treat extrapyramidal motor disorder namely dyskinesia, tremors, rigidity, and dystonia [75–77]. GPi-DBS, in primary generalized dystonia, was proved to be very successful, and it can be used as an effective treatment option [78]. Although with mild treatment side effects, a number of studies have shown positive treatment outcome in chronic disorders of consciousness with unknown mechanism of action [79]. DBS is found to beneficial in enhancing altered learning and memory. In rodents' model of dementia, mesial temporal DBS has shown positive results. Improvement in visual memory is seen in patients who underwent unilateral amygdalohippocampal DBS [80]. DBS helps in regaining of learning, memory, and altered communication skills

in patients of postbrain injury with disorders of consciousness [81].

Severe harmful effects of DBS are seen on dominant side of hippocampal region. Bilateral hippocampal DBS may cause memory dysfunction in epilepsy patients. Though DBS, is supposed to be safe, the adverse events can be seen in 7.5–8.5% of patients. The major adverse effects being, infections, intraoperative seizures and

**8.4 Obsessive: compulsive disorder**

OCD symptoms [69].

**8.5 Anorexia nervosa**

pathic pain [30, 71, 72].

**10. Positive influence of the DBS treatment**

**11. Negative influence of the treatment**

**9. Pain**

**38**

other complications [7].

DBS is a neurosurgical procedure that utilizes lead-implanted electrodes that is placed chronically in the target areas of the brain well connected to pulse generator, which excites the neuronal circuits [1, 4, 5]. It is an invasive neuromodulation technique that was emanated in early 1960s [1]. Recently, DBS has become a huge practice in treatment of various movement disorders along with some psychiatric disorders [4, 5]. As compared to other neurosurgical options, lower chances of complications are seen with this technique [5]. Although with mild treatment side effects, a number of studies have shown positive treatment outcome in chronic disorders of consciousness with unknown mechanism of action [79]. Growth in DBS in respect to pathway and its impact on neuronal circuit has been mainly propelled by preclinical, neurophysiological, and computational research. Significant needs and prospect have evolved innovative techniques and technologies that have improved tolerability as well as research design, but DBS is still growing in many areas to manage cerebral diseases safely and efficiently.
