Is deep brain stimulation effective and safe for patients with obsessive compulsive disorder and comorbid bipolar disorder?
Is deep brain stimulation effective and safe for patients with obsessive compulsive disorder and comorbid bipolar disorder?
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DOI：
10.1016/j.jad.2019.11.152
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发表时间：
2020-03-01
影响因子：
6.6
通讯作者：
Denys, Damiaan
中科院分区：
文献类型：
--
作者：
Graat, Ilse;van Rooijen, Geeske;Denys, Damiaan
背景：脑深部电刺激（DBS）是治疗难治性强迫症（OCD）的有效方法。双相情感障碍（BD）通常被认为是禁忌症DBS由于经常报告的短暂冲动或（低）mania.Objective：本研究是第一项研究，以检查有效性和安全性的DBS患者与强迫症和BD.Methods：五个连续的患者患有难治性强迫症与共病BD（I或II）进行DBS的腹侧前肢的内囊（VALIC）。我们使用耶鲁-布朗强迫量表（Y-BOCS）和汉密尔顿抑郁量表（HAM-D）检查DBS对强迫症和抑郁症状的有效性。我们监测副作用，特别是DBS诱导的（低）躁狂症状，使用杨躁狂量表（YMRS）。结果：随访时间范围为15至68个月。vALIC-DBS显著改善了强迫症和抑郁症状。平均Y-BOCS评分从36.8（SD 2.4）降至22.4（SD 9.4）。平均HAM-D评分从24.2（SD 8.6）降至16.5（SD 11.3）。在5例患者中的4例中观察到一过性轻躁狂症状，1例患者通过调整刺激和药物治疗缓解了轻躁狂症状。YMRS评分变化不显著。轻躁狂症状并没有导致入院或持久的不良后果。结论：DBS有效地缓解了强迫症和抑郁症的患者与强迫症和BD的症状，但有很大的风险发展为短暂的轻躁狂症状。总之，合并BD不应被视为合并BD的OCD患者DBS的绝对禁忌症，但在DBS优化和随访期间应仔细监测患者。
Background: Deep brain stimulation (DBS) is an effective treatment for refractory obsessive-compulsive disorder (OCD). Bipolar disorder (BD) is generally considered a contra-indication for DBS due to frequently reported transient impulsivity or (hypo)mania.Objective: The present study is the first study to examine effectiveness and safety of DBS for patients with OCD and BD.Methods: Five consecutive patients suffering from treatment-refractory OCD with comorbid BD (I or II) underwent DBS of the ventral anterior limb of the internal capsule (vALIC). We examined effectiveness of DBS on symptoms of OCD and depression, using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Hamilton Depression Rating Scale (HAM-D). We monitored side-effects, in particular DBS-induced (hypo)manic symptoms, using the Young mania rating scale (YMRS).Results: Follow-up time ranged between 15 and 68 months. vALIC-DBS led to a significant improvement of OCD and depressive symptoms. Mean Y-BOCS score decreased from 36.8 (SD 2.4) to 22.4 (SD 9.4). Mean HAM-D score dropped from 24.2 (SD 8.6) to 16.5 (SD 11.3). Transient hypomanic symptoms were observed in 4 out of 5 patients and in 1 patient, hypomanic symptoms resolved by adjusting stimulation and medication. Changes in YMRS scores were not significant. Hypomanic symptoms did not result in admission or lasting adverse consequences.Conclusion: DBS effectively alleviates symptoms of OCD and depression in patients with OCD and BD but there is a large risk of developing transient hypomanic symptoms. Altogether, comorbid BD should not be considered as an absolute contra-indication for DBS in OCD patients with comorbid BD, but patients should be monitored carefully during optimization and follow-up of DBS.