High-frequency stimulation of deep brain structures in obsessive-compulsive disorder: the search for a valid circuit
High-frequency stimulation of deep brain structures in obsessive-compulsive disorder: the search for a valid circuit
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DOI：
10.1111/j.1460-9568.2010.07418.x
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发表时间：
2010-10-01
影响因子：
3.4
通讯作者：
Mallet, Luc
中科院分区：
文献类型：
--
作者：
Haynes, William I. A.;Mallet, Luc
强迫症 (OCD) 是一种常见的致残性精神疾病，结合了侵入性思维（强迫观念）和重复行为（强迫行为）。尽管大多数患者对传统的药物和/或心理治疗反应良好，但 25-30% 的患者在治疗后未能改善，通常症状极其严重。深部脑结构（包括基底神经节）的高频刺激是一种针对运动障碍而开发的手术技术，也称为深部脑刺激（DBS），已被提议作为这些棘手病例的消融手术的替代方案。在这里，我们回顾了科学数据，解释了为什么目前正在研究这种技术在强迫症中的应用，从基于神经影像研究（解剖学和功能性）的第一个假设到最近的动物模型和临床观察。概述了每个临床试验的总体结果，以讨论其与病理生理学的关系；然而，没有给出更具体的临床信息（副作用、潜伏期和其他行为改变）。最后，描述了源自这些数据的强迫症模型以及它们如何受到 DBS 的影响。
Obsessive-compulsive disorder (OCD) is a common, disabling, psychiatric disease combining intrusive thoughts (obsessions) and repetitive behaviours (compulsions). Although most patients respond well to conventional pharmacological and/or psychological therapy, 25-30%, often with extremely severe symptoms, fail to improve after treatment. High-frequency stimulation of deep brain structures (basal ganglia included), a surgical technique developed for movement disorders and otherwise known as deep brain stimulation (DBS), has been proposed as an alternative to ablative surgery for these intractable cases. Here, we review the scientific data that explain why the use of this technique is currently being investigated in OCD, from the first hypotheses based on neuroimaging studies (anatomical and functional) to more recent animal models and clinical observations. The general outcome of each clinical trial is outlined in order to discuss its relation to pathophysiology; however, more specific clinical information (side-effects, latencies, and other behavioural modifications) is not given. Finally, a description of the models of OCD that stem from these data and how they might be affected by DBS is provided.