A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder.
A Systematic Review of Deep Brain Stimulation Targets for Obsessive Compulsive Disorder.
复制标题
强迫症深部脑刺激目标的系统回顾。
DOI：
10.1093/neuros/nyaa249
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发表时间：
2020
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：
Raviv,Nataly;Staudt,MichaelD;Rock,AndrewK;MacDonell,Jacquelyn;Slyer,Julia;Pilitsis,JulieG
背景强迫症是一种以强迫症和强迫症为特征的复杂的神经精神疾病。脑深部刺激(DBS)已证明在改善药物难治性患者的症状方面有效。目的系统回顾目前支持强迫症-DBS的证据水平和质量，以期建立一个共同的命名方法。方法利用PubMed数据库和以“DBS”和“OCD”为关键词的患者/问题、干预、比较、结果搜索进行系统的文献综述。在86篇经过全文审查的符合条件的文章中，有28篇纳入审查。如果未明确目标、关注非临床结果、随访期小于3个月或样本量小于3个受试者，则排除这些文章。证据水平是根据美国神经外科医生协会/神经外科医生大会联合指南委员会的建议分配的。结果纳入文献9篇，随机对照试验9篇，队列研究1篇，病例对照研究1篇，横断面研究1篇，病例系列16篇。纹状体区域的目标，如内囊前肢、腹囊/腹侧纹状体和伏隔核，尽管结构名称不同，但立体定向坐标相似。28篇文章中只有15篇包含坐标。结论纹状体区域是强迫症-DBS最常见的靶区。我们在此综述的基础上推荐一个通用的命名法。为了将这一领域向前推进到个体化治疗，需要报告相对于立体定向坐标的主动接触位置以及患者特定的解剖和临床差异。
BACKGROUNDObsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated.OBJECTIVETo systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature.METHODSA systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms “DBS” and “OCD.” Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.RESULTSSelected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates.CONCLUSIONThe striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.