Marked Response to VNS in a Post-Cingulotomy Patient: Implications for the Mechanism of Action of VNS in TRD.
Marked Response to VNS in a Post-Cingulotomy Patient: Implications for the Mechanism of Action of VNS in TRD.
复制标题
扣带回切开术后患者对 VNS 的显着反应：对 TRD 中 VNS 作用机制的影响。
DOI：
10.1017/s1092852912000302
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发表时间：
2011
期刊：
影响因子：
3.3
通讯作者：
Bucholz,RichardD
中科院分区：
文献类型：
--
作者：
Conway,CharlesR;Gebretsadik,MehretD;Bucholz,RichardD
难治性重度抑郁症(TRMD，对多种治疗无效的重度抑郁症)是一种相对常见且具有临床挑战性的疾病。在许多情况下，受影响最严重的TRMD患者接受了手术治疗(尾状体束下切开术、边缘白质切开术、前囊膜切开术和前扣带切开术)。出现了包括迷走神经刺激(VNS)和脑深部刺激在内的新疗法来治疗TRMD患者。我们描述了一例女性，53岁，有长期和持续的TRMD病史(33年)，对多种治疗(多种药物治疗、心理治疗、电休克治疗[ECT])无效。此外，她的TRMD对双侧前扣带回切开术没有反应。她接受了颈部迷走神经刺激器的放置和简短的ECT疗程(3次单侧治疗)。她的抑郁明显改善，并持续缓解了3.5年。此病例提示了VNS和ECT的潜在协同作用，并为TRMD中VNS的神经回路提供了可能的线索。
Treatment-resistant major depression (TRMD, major depressive disorder that fails to respond to numerous therapies) is a relatively common and clinically challenging disorder. In many cases, the most severely affected TRMD patients have received surgical intervention (subcaudate tractotomy, limbic leucotomy, anterior capsulotomy, and anterior cingulotomy). New treatments, including vagus nerve stimulation (VNS) and deep brain stimulation, have emerged to treat individuals with TRMD. We describe the case of a woman, 53 years of age, with a long and sustained history of TRMD (33 years), which was unresponsive to numerous treatments (multiple pharmacotherapies, psychotherapy, electroconvulsive therapy [ECT]). Additionally, her TRMD failed to respond to a bilateral anterior cingulotomy. She underwent placement of a cervical vagus nerve stimulator and a brief course of ECT (3 unilateral treatments). Her depression improved markedly, and it has remained in sustained remission for 3.5 years. This case suggests a potential synergistic effect of VNS and ECT, as well as provides possible clues to the neural circuitry of VNS in TRMD.