Deep brain stimulation for treatment-resistant depression
Deep brain stimulation for treatment-resistant depression
复制标题
DOI：
10.1016/j.neuron.2005.02.014
复制
发表时间：
2005-03-03
期刊：
影响因子：
16.2
通讯作者：
Kennedy, SH
中科院分区：
文献类型：
--
作者：
Mayberg, HS;Lozano, AM;Kennedy, SH
难治性抑郁症是一种严重的致残障碍，一旦多种药物、心理治疗和电休克治疗失败，就没有经过验证的治疗选择。基于我们对难治性抑郁症患者扣带回亚区(Brodmann区25)代谢过度活跃的初步观察，我们研究了应用慢性脑深部刺激来调节BA25是否可以降低这种升高的活性，并在6例难治性抑郁症患者中产生临床益处。在六名患者中，有四名患者对膝下扣带回附近白质束的慢性刺激与抑郁的显著和持续缓解有关。通过正电子发射断层扫描测量，抗抑郁作用与局部脑血流量的显著减少以及下游边缘和皮质部位的变化有关。这些结果表明，通过电刺激膝下扣带白质来扰乱边缘-皮质环路的局灶性病理活动，可以有效地逆转其他难治性抑郁症的症状。
Treatment-resistant depression is a severely disabling disorder with no proven treatment options once multiple medications, psychotherapy, and electroconvulsive therapy have failed. Based on our preliminary observation that the subgenual cingulate region (Brodmann area 25) is metabolically overactive in treatment resistant depression, we studied whether the application of chronic deep brain stimulation to modulate BA25 could reduce this elevated activity and produce clinical benefit in six patients with refractory depression. Chronic stimulation of white matter tracts adjacent to the subgenual cingulate gyrus was associated with a striking and sustained remission of depression in four of six patients. Antidepressant effects were associated with a marked reduction in local cerebral blood flow as well as changes in downstream limbic and cortical sites, measured using positron emission tomography. These results suggest that disrupting focal pathological activity in limbic-cortical circuits using electrical stimulation of the subgenual cingulate white matter can effectively reverse symptoms in otherwise treatment-resistant depression.