Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up After 3 to 6 Years
Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up After 3 to 6 Years
复制标题
DOI：
10.1176/appi.ajp.2010.10081187
复制
发表时间：
2011-05-01
影响因子：
17.7
通讯作者：
Lozano, Andres M.
中科院分区：
文献类型：
--
作者：
Kennedy, Sidney H.;Giacobbe, Peter;Lozano, Andres M.
目的：至少30%的难治性抑郁症的患病率促使人们研究替代治疗策略。脑深部刺激(DBS)是一种很有前景的靶向治疗方法，它涉及在特定的神经解剖部位放置双侧电极。考虑到DBS治疗难治性抑郁症的侵入性和实验性，获得短期和长期的有效性和安全性数据是很重要的。这篇报道描述了20名接受DBS治疗的难治性抑郁症患者的长期随访。方法：在最初12个月的DBS研究后，每年和最后一次随访患者评估抑郁的严重程度、功能结果和不良事件。结果：DBS植入后1、2和3年的平均应答率分别为62.5%、46.2%和75%。最后一次随访3~6年，平均有效率为64.3%。身体健康和社会功能领域的功能损害在最后一次后续访问之前逐渐得到改善。虽然有两名患者在抑郁复发期间自杀身亡，但在本次随访中没有重大不良事件的报道。结论：这些数据表明，从长远来看，DBS仍然是治疗难治性抑郁症的安全有效的治疗方法。为了证实这些发现，还需要进行更多的大样本试验。
Objective: A prevalence of at least 30% for treatment-resistant depression has prompted the investigation of alternative treatment strategies. Deep brain stimulation (DBS) is a promising targeted approach involving the bilateral placement of electrodes at specific neuroanatomical sites. Given the invasive and experimental nature of DBS for treatment-resistant depression, it is important to obtain both short-term and long-term effectiveness and safety data. This report represents an extended follow-up of 20 patients with treatment-resistant depression who received DBS to the subcallosal cingulate gyrus (Brodmann's area 25).Method: After an initial 12-month study of DBS, patients were seen annually and at a last follow-up visit to assess depression severity, functional outcomes, and adverse events.Results: The average response rates 1, 2, and 3 years after DBS implantation were 62.5%, 46.2%, and 75%, respectively. At the last follow-up visit (range= 3-6 years), the average response rate was 64.3%. Functional impairment in the areas of physical health and social functioning progressively improved up to the last follow-up visit. No significant adverse events were reported during this follow-up, although two patients died by suicide during depressive relapses.Conclusions: These data suggest that in the long term, DBS remains a safe and effective treatment for treatment-resistant depression. Additional trials with larger samples are needed to confirm these findings.