Deep brain stimulation: a return journey from psychiatry to neurology
Deep brain stimulation: a return journey from psychiatry to neurology
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DOI：
10.1136/postgradmedj-2012-131520
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发表时间：
2013-06-01
影响因子：
5.1
通讯作者：
Samuel, Michael
中科院分区：
文献类型：
--
作者：
Ashkan, Keyoumars;Shotbolt, Paul;Samuel, Michael
脑深部电刺激（DBS）已成为治疗一系列疾病的有效神经外科工具。它在运动障碍，如帕金森氏病，震颤和肌张力障碍中的应用现已得到很好的确立，并已获得国家临床卓越研究所（NICE）的批准。然而，NICE强调需要一个多学科团队来管理这些患者。这样的团队传统上由神经学家、神经外科医生和神经心理学家组成。然而，神经精神科医生越来越被认为是必要的成员，因为许多精神方面的考虑可能会出现在接受DBS的患者。病人的选择、同意能力的评估和术后精神疾病的治疗只是神经精神病学投入非常宝贵的几个领域。部分是由于这种密切的团队合作，部分是基于DBS治疗精神疾病的早期历史，人们越来越有兴趣重新探索神经外科治疗精神疾病患者的潜力，如抑郁症和强迫症。尽管DBS在这组患者中的临床经验和证据正在稳步增加，但许多问题仍未得到解答。然而，对于大多数精神疾病，最佳手术候选人的特征、DBS靶点的最佳选择、最有效的刺激参数和术后改善的程度尚不清楚。因此，需要进一步的研究来确定如何最好地利用DBS来改善精神疾病患者的生活质量。
Deep brain stimulation (DBS) has emerged as an effective neurosurgical tool to treat a range of conditions. Its use in movement disorders such as Parkinson's disease, tremor and dystonia is now well established and has been approved by the National Institute of Clinical Excellence (NICE). The NICE does, however, emphasise the need for a multidisciplinary team to manage these patients. Such a team is traditionally composed of neurologists, neurosurgeons and neuropsychologists. Neuropsychiatrists, however, are increasingly recognised as essential members given many psychiatric considerations that may arise in patients undergoing DBS. Patient selection, assessment of competence to consent and treatment of postoperative psychiatric disease are just a few areas where neuropsychiatric input is invaluable. Partly driven by this close team working and partly based on the early history of DBS for psychiatric disorders, there is increasing interest in re-exploring the potential of neurosurgery to treat patients with psychiatric disease, such as depression and obsessive-compulsive disorder. Although the clinical experience and evidence with DBS in this group of patients are steadily increasing, many questions remain unanswered. Yet, the characteristics of optimal surgical candidates, the best choice of DBS target, the most effective stimulating parameters and the extent of postoperative improvement are not clear for most psychiatric conditions. Further research is therefore required to define how DBS can be best utilised to improve the quality of life of patients with psychiatric disease.