Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression - Case report
Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression - Case report
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DOI：
10.3171/jns.2004.101.4.0682
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发表时间：
2004-10-01
影响因子：
4.1
通讯作者：
Burbaud, P
中科院分区：
文献类型：
--
作者：
Aouizerate, B;Cuny, E;Burbaud, P
强迫症(OCD)是一种与反复侵入性思维和重复行为相关的焦虑症。虽然传统的药物和/或心理治疗在治疗强迫症方面是成熟和有效的，但高达30%的患者的症状保持不变。最近，内囊前肢深部脑刺激(DBS)被认为是治疗难治性强迫症的一种可能的替代方案。在目前的研究中，作者验证了这样的假设，即尾状核腹侧DBS对难治性严重强迫症和伴发严重抑郁症的患者可能有效。精神病学评估包括Yale-Brown强迫量表(Y-BOCS)、汉密尔顿抑郁量表(HDRS)、汉密尔顿焦虑量表(HARS)和全球功能评定量表(GAF)，分别用于确定强迫症、抑郁和焦虑的症状严重程度以及心理社会和职业功能的质量。神经心理学评估包括广泛的测试，主要是探索记忆和执行功能。脑深部刺激尾状核腹侧核可明显改善抑郁和焦虑症状，直至症状缓解，刺激开始后6个月(HDRS小于等于7，HARS小于或等于10)。强迫症(Y-BOCS<；16)的缓解也在DBS治疗12或15个月后延迟。在15个月的随访期内，根据GAF量表的功能水平逐步提高。未观察到神经心理恶化，提示尾状核腹侧DBS可能是治疗强迫症和重度抑郁症难治性病例的一种有前途的策略。
Obsessive-compulsive disorder (OCD) is an anxiety disorder associated with recurrent intrusive thoughts and repetitive behaviors. Although conventional pharmacological and/or psychological treatments are well established and effective in treating OCD, symptoms remain unchanged in up to 30% of patients. Deep brain stimulation (DBS) of the anterior limb of the internal capsule has recently been proposed as a possible therapeutic alternative in treatment-resistant OCD. In the present Study, the authors tested the hypothesis that DBS of the ventral caudate nucleus might be effective in a patient with intractable severe OCD and concomitant major depression. Psychiatric assessment included the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), and the Global Assessment of Functioning (GAF) Scale for determining the symptom severity of OCD, depression, and anxiety as well as the quality of pychosocial and occupational functioning, respectively. Neuropsychological assessment consisted of a wide range of tests primarily exploring memory and executive functions. Deep brain stimulation of the ventral caudate nucleus markedly improved symptoms of depression and anxiety until their remission, which was achieved at 6 months after the start of stimulation (HDRS less than or equal to 7 and HARS less than or equal to 10). Remission of OCD (Y-BOCS < 16) was also delayed after 12 or 15 months of DBS. The level of functioning pursuant to the GAF scale progressively increased during the 15-month follow-up period. No neuropsychological deterioration was observed, indicating that DBS of the ventral caudate nucleus could be a promising strategy in the treatment of refractory cases of both OCD and major depression.