Evidence map›Paper›PMID 42067731›Full record

SynthesisNeurosurgical review2026

Deep brain stimulation for clozapine-resistant schizophrenia: a systematic review of target-specific outcomes and stereotactic technical considerations.

Alivery Raihanada Armando, Achmad Fahmi, Heri Subianto, Agus Turchan, Wei Wang, Youheng Peng, Muhammad Fadhil Kamaruddin, Ramidha Syaharani, Ramadhani Rizki Zamzam, Nathania Maulina

Abstract readSystematic Review
In one paragraph

Synthesis in Neurosurgical review, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Alivery Raihanada ArmandoFaculty of Medicine, Airlangga University, Surabaya, Indonesia.ORCID http://orcid.org/0000-0003-2390-5761
Achmad FahmiFaculty of Medicine, Airlangga University, Surabaya, Indonesia. drachmadfahmi@gmail.com.ORCID http://orcid.org/0000-0003-0464-5482
Heri SubiantoFaculty of Medicine, Airlangga University, Surabaya, Indonesia. heri.subianto@yahoo.com.ORCID http://orcid.org/0000-0003-2778-1452
Agus TurchanFaculty of Medicine, Airlangga University, Surabaya, Indonesia.
Wei WangDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Youheng PengDepartment of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Muhammad Fadhil KamaruddinFaculty of Medicine, Airlangga University, Surabaya, Indonesia.
Ramidha SyaharaniFaculty of Medicine, Airlangga University, Surabaya, Indonesia.
Ramadhani Rizki ZamzamFaculty of Medicine, Airlangga University, Surabaya, Indonesia.
Nathania MaulinaFaculty of Medicine, Airlangga University, Surabaya, Indonesia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Treatment-resistant schizophrenia (TRS) affects approximately 20-30% of patients, and a substantial proportion develop clozapine-resistant schizophrenia (CRS). Deep brain stimulation (DBS) has emerged as a potential neurosurgical intervention targeting dysfunctional cortico-striato-limbic circuitry. However, technical heterogeneity and limited clinical data constrain interpretation of outcomes. This systematic review was conducted in accordance with PRISMA guidelines and prospectively registered in PROSPERO (CRD420251080715). Seven electronic databases were searched from inception through January 31, 2025. Clinical studies investigating DBS in TRS or CRS were included. Methodological quality was assessed using Joanna Briggs Institute (JBI) tools. Data extraction emphasized stereotactic targeting methods, hardware configurations, stimulation parameters, and clinical outcomes. The total number of study is 6. We excluded paper by Manssuer 2023. The total study population comprises 21 patients. Seven studies involving 21 patients met inclusion criteria. Targets included the nucleus accumbens (NAcc; n = 11), substantia nigra (SNr; n = 1), habenula (HB; n = 2), subgenual cingulate (SCG; n = 4), subgenual anterior cingulate cortex (sgACC; n = 3). Reported PANSS total score changes ranged widely (11%-85.7%), reflecting substantial inter-individual variability and methodological limitations. Surgical complications occurred in 3 of 21 patients (14.2%), including infection and hemorrhage. All cases utilized open-loop stimulation and conventional cylindrical leads. Current evidence suggests a preliminary therapeutic signal for DBS in highly selected CRS patients, particularly with NAcc targeting. However, conclusions remain limited by small sample sizes, technical heterogeneity, and absence of controlled trials. Future investigations should prioritize standardized stereotactic reporting, volumetric lead reconstruction, and long-term safety assessment within specialized neurosurgical research settings. PROSPERO CRD420251080715.

Indexed as

Deep Brain StimulationSchizophreniaSchizophrenia, Treatment-ResistantStereotaxic TechniquesAntipsychotic AgentsClozapineHumansTreatment OutcomeAntipsychotic AgentsClozapineClozapine-resistant schizophreniaDeep brain stimulationNeuromodulationNeurosurgical techniquePsychosurgeryStereotactic surgery, neurosurgeryTreatment-resistant schizophrenia

Identifiers

PMID42067731
PMCPMC13135008

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.