Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution
Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution
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DOI：
10.3389/fpsyt.2020.00055
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发表时间：
2020-02-28
影响因子：
4.7
通讯作者：
Greenlee, Jeremy D. W.
中科院分区：
文献类型：
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作者：
Holland, Marshall T.;Trapp, Nicholas T.;Greenlee, Jeremy D. W.
介绍脑深部电刺激（DBS）是一种经过验证的治疗运动障碍的有效工具。DBS的适应症扩展到神经精神障碍领域，特别是强迫症（OCD），已经获得了热烈的兴趣，尽管关于适当的临床应用的数据仍然有限。（植入前平均YBOC评分为34.2 +/- 2.5）接受腹侧囊/腹侧纹状体DBS治疗，与平均随访54.8 months.ResultsWith慢性刺激（年），大多数患者取得了显着的好处，在强迫症和抑郁症状。6例患者在植入后经历了强迫症缓解期。6个响应者中有4个需要12个月以上才能实现响应。六分之四患有共病抑郁症的患者的重度抑郁症状得到缓解。实现有效性所需的设置高于通常用于运动障碍的设置，需要增加脉冲发生器（IPG）电池需求。我们发现患者从转换为可充电IPG中受益，以避免IPG更换的系列手术。对于可充电IPG的患者，重复充电的习惯并没有出现加重或引发新的强迫行为或焦虑symptoms.ConclusionsOur研究支持和建立在其他研究表明，DBS的强迫症在现实世界的设置可以成功地实施，并提供长期的利益严重影响的强迫症患者。讨论了最佳患者选择和DBS程控标准。在该人群中，可充电IPG的使用似乎具有成本效益且耐受性良好。
IntroductionDeep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Expansion of indications for DBS into the realm of neuropsychiatric disorders, especially obsessive-compulsive disorder (OCD), has gained fervent interest, although data on appropriate clinical utilization remains limited.MethodsA retrospective, naturalistic study followed nine severely affected OCD patients (average YBOCs score before implantation 34.2 +/- 2.5) treated with DBS of ventral capsule/ventral striatum, with average follow up of 54.8 months.ResultsWith chronic stimulation (years), a majority of the patients achieved significant benefits in obsessive-compulsive and depressive symptoms. Six patients experienced periods of OCD remission following implantation. Four of the six responders required more than 12 months to achieve response. Relief of major depressive symptoms occurred in four out of six patients with documented co-morbid depression. Settings required to achieve efficacy were higher than those typically utilized for movement disorders, necessitating increased impulse generator (IPG) battery demand. We found patients benefited from conversion to a rechargeable IPG to prevent serial operations for IPG replacement. For patients with rechargeable IPGs, the repetitive habit of recharging did not appear to aggravate or trigger new obsessive-compulsive behaviors or anxiety symptoms.ConclusionsOur study supports and builds upon other research suggesting that DBS for OCD in a real-world setting can be implemented successfully and provide long-term benefit for severely affected OCD patients. Optimal patient selection and DBS programming criteria are discussed. The use of rechargeable IPGs appears to be both cost effective and well-tolerated in this population.