Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design.
Deep brain stimulation for intractable obsessive compulsive disorder: pilot study using a blinded, staggered-onset design.
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DOI：
10.1016/j.biopsych.2009.11.028
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发表时间：
2010-03-15
影响因子：
10.6
通讯作者：
Okun MS
中科院分区：
文献类型：
--
作者：
Goodman WK;Foote KD;Greenberg BD;Ricciuti N;Bauer R;Ward H;Shapira NA;Wu SS;Hill CL;Rasmussen SA;Okun MS
先前有报道称，在用尽常规治疗的严重强迫症(OCD)患者中，对内囊前肢进行脑深部刺激(DBS)取得了良好的结果。在这项初步研究中，6名成年患者(2名男性，4名女性)符合严格的严重标准(最低Yale-Brown强迫量表[Y-BOCS]为28)和治疗难治性强迫症，将DBS电极阵列放置在跨越内囊腹侧前肢和相邻腹侧纹状体(称为腹囊/腹侧纹状体)的区域的两侧。采用随机、交错发病的设计，患者在手术后30天或60天在盲目条件下接受刺激。经过12个月的刺激，6名患者中有4名(66.7%)达到了严格的“应答者”标准(Y-BOCS和终点Y-BOCS严重程度≥16分别改善了35%和35%)。患者在假刺激期间没有改善。作为一个整体，这组人的抑郁症状显著改善；四名应答者的全球功能有所改善。与慢性DBS相关的不良事件通常很轻微，并且可以随着环境的变化而改变。在两个病例中，刺激中断导致快速但可逆的抑郁症状。这项初步研究表明，腹侧包膜/腹侧纹状体区域的DBS对于精心挑选的严重和难治性强迫症患者来说是一种有前途的最后手段。未来的研究应关注受试者的选择、导联位置、DBS编程以及支持治疗益处的机制。
Prior promising results have been reported with deep brain stimulation (DBS) of the anterior limb of the internal capsule in cases with severe obsessive compulsive disorder (OCD) who had exhausted conventional therapies. In this pilot study, six adult patients (2 male; 4 female) meeting stringent criteria for severe (minimum Yale-Brown Obsessive Compulsive Scale [Y-BOCS] of 28) and treatment-refractory OCD had DBS electrode arrays placed bilaterally in an area spanning the ventral anterior limb of the internal capsule and adjacent ventral striatum referred to as the ventral capsule/ventral striatum. Using a randomized, staggered-onset design, patients were stimulated at either 30 or 60 days following surgery under blinded conditions. After 12 months of stimulation, four (66.7%) of six patients met a stringent criterion as “responders” (≥35% improvement in the Y-BOCS and end point Y-BOCS severity ≤16). Patients did not improve during sham stimulation. Depressive symptoms improved significantly in the group as a whole; global functioning improved in the four responders. Adverse events associated with chronic DBS were generally mild and modifiable with setting changes. Stimulation interruption led to rapid but reversible induction of depressive symptoms in two cases. This pilot study suggests that DBS of the ventral capsule/ventral striatum region is a promising therapy of last resort for carefully selected cases of severe and intractable OCD. Future research should attend to subject selection, lead location, DBS programming, and mechanisms underpinning therapeutic benefits.
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