In Reply: A Systematic Review of Deep Brain Stimulation Targets for Obsessive-Compulsive Disorder.
In Reply: A Systematic Review of Deep Brain Stimulation Targets for Obsessive-Compulsive Disorder.
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答复：强迫症深部脑刺激目标的系统回顾。
DOI：
10.1093/neuros/nyab010
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发表时间：
2021
期刊：
影响因子：
4.8
通讯作者：
Pilitsis,JulieG
中科院分区：
文献类型：
--
作者：
Hadanny,Amir;Pilitsis,JulieG
致编辑：我们要感谢作者1对我们的研究感兴趣，2感谢编辑让我们有机会做出回应。我们同意Menchón et al 3前瞻性研究与我们的系统性综述高度相关;不幸的是，它是在我们的文献检索日期（2000年1月至2019年9月）之后发表的（2019年10月）。他们关于用于最佳刺激的阴极位置的工作与讨论高度相关。我们同意使用连接体方法可以改善强迫症（OCD）脑深部电刺激（DBS）的结局。DBS的临床效果至少部分归因于连接不同靶点的白色纤维束的激活。在DBS治疗重度抑郁症中，使用个体化纤维束描记术已被证明可导致更高的应答率。4类似地，基于纤维束成像的靶向治疗改善了原发性震颤和帕金森病的临床结局。5-8 Makris等9表明，纹状体区域中个别眶额丘脑通道纤维的形态是复杂的。基于对22名强迫症患者的分析，Baldermann等人10认为，必须调节额丘脑通路以获得有益的结局。Liebrand等人11表明，主动刺激靠近内侧额束的内囊前肢（ALIC）与更好的结局相关。Li等人12证实，额束刺激可预测4个不同队列的临床结局。因此，纹状体-额叶连接可能对OCD DBS靶向具有有希望的改善，这需要前瞻性地证实。总之，我们感谢信件作者花时间添加到文献中，并倡导使用个体化连接体方法，这可能会推动DBS领域的发展，特别是在效果不明显的疾病中。
To the Editor: We would like to thank the authors 1 for their interest in our study, 2 and the Editor for allowing us the opportunity to respond. We agree that the Menchón et al 3 prospective study is highly relevant to our systematic review; unfortunately, it was published (October 2019) after the dates our literature search incorporated (January 2000-September 2019). Their work on the location of cathodes used for optimal stimulation is highly relevant to the discussion. We agree the use of the connectome approach may improve obsessive-compulsive disorder (OCD) deep brain stimulation (DBS) outcomes. The clinical effects of DBS are due at least in part to the activation of white matter fiber tracts, which connect different targets. In DBS for major depressive disorder, the use of individualized tractography has been shown to lead to higher response rates. 4 Similarly, improved clinical outcomes in both essential tremor and Parkinson’s disease have been suggested with tractography-based targeting. 5-8 Makris et al 9 showed that the morphology of the individual orbito-fronto-thalamic fibers of passage in the striatal region is complex. Based on 22 OCD patients’ analysis, Baldermann et al 10 suggested that a fronto-thalamic pathway must be modulated for beneficial outcomes. Liebrand et al 11 showed that active stimulation of the anterior limb of the internal capsule (ALIC) closer to the medial frontal bundle was associated with better outcomes. Li et al 12 confirmed that frontal bundle stimulation can predict clinical outcomes in 4 different cohorts. Thus, the striatal-frontal connectivity may hold promising improvements to OCD DBS targeting, which needs to be confirmed prospectively. In summary, we thank the letter authors for taking the time to add to the literature and advocate the use of the individualized connectome approach, which may advance the field of DBS, particularly in disorders where results are not immediate.