Bilateral epidural prefrontal cortical stimulation for treatment-resistant depression.
Bilateral epidural prefrontal cortical stimulation for treatment-resistant depression.
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DOI：
10.1016/j.biopsych.2009.08.021
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发表时间：
2010-01-15
影响因子：
10.6
通讯作者：
Takacs, Istvan
中科院分区：
文献类型：
--
作者：
Nahas, Ziad;Anderson, Berry S.;Borckardt, Jeff;Arana, Ashley B.;George, Mark S.;Reeves, Scott T.;Takacs, Istvan
关键词：
难治性抑郁症对患者和临床医生都提出了严峻的挑战。前额叶前部和中外侧皮层在整合情感和认知体验以及调节皮层下区域方面发挥互补作用。这两个地区都为靶向抗抑郁治疗提供了独特的机会。我们选择在难治性抑郁症患者中试验慢性和间歇性硬膜外前额叶皮层刺激（EpCS）的安全性和治疗益处。我们招募了5名成年人，他们在当前的抑郁发作中平均有5.8次抗抑郁治疗失败。所有受试者均接受了全面的临床评估、详细的神经心理学测试和术前磁共振成像。四个皮层刺激桨式电极导线立体定位放置在双侧前额叶极和中外侧前额叶皮层。我们还获得了术后计算机断层扫描，并反复评估了EpCS作为持续药物治疗的后续治疗随时间推移的临床结局。所有患者均能耐受治疗。7个月随访时，汉密尔顿抑郁评定量表和抑郁症状自评量表较植入前基线的平均改善分别为54.9%（± 37.7）和60.1%（± 34.1）。3例植入受试者达到缓解。1例患者的左半球电极导线在术后12周因头皮感染而拔除。双侧前额叶和中外侧额叶皮质EpCS是治疗难治性抑郁症的一项有前途的新技术。未来的双盲研究是必要的。
Treatment-resistant depression presents a serious challenge to both patients and clinicians. The anterior and midlateral prefrontal cortices play complementary roles in integrating emotional and cognitive experiences and in modulating subcortical regions. Both regions offer a distinct opportunity for targeted antidepressant treatments. We chose to pilot the safety and therapeutic benefits of chronic and intermittent epidural prefrontal cortical stimulation (EpCS) in patients with treatment-resistant depression. We enrolled five adults with an average of 5.8 failed antidepressant treatments in their current depressive episode. All subjects underwent comprehensive clinical assessments, detailed neuropsychological testing, and presurgical magnetic resonance imaging. Four cortical stimulation paddle leads were stereotactically placed bilaterally over the anterior frontal poles and midlateral prefrontal cortex. We also acquired a postsurgical computed tomography scan and repeatedly assessed clinical outcomes over time of EpCS as an adjunctive treatment to constant medications. All patients tolerated the therapy. At 7-month follow-up, the average improvement from preimplant baseline on the Hamilton Rating Scale for Depression and the Inventory of Depressive Symptoms—Self-Report were 54.9% (± 37.7) and 60.1% (± 34.1), respectively. Three implanted subjects reached remission. One patient's left hemisphere leads were explanted 12 weeks postsurgery because of a scalp infection. Bilateral EpCS over anterior and midlateral frontal cortex is a promising new technology for treatment-resistant depression. Future double-blind studies are warranted.
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