Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder
Three-year outcomes in deep brain stimulation for highly resistant obsessive-compulsive disorder
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DOI：
10.1038/sj.npp.1301165
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发表时间：
2006-11-01
影响因子：
7.6
通讯作者：
Rasmussen, Steven A.
中科院分区：
文献类型：
--
作者：
Greenberg, Benjamin D.;Malone, Donald A.;Rasmussen, Steven A.
已证明，内囊前肢的脑深部刺激（DBS）在短期内对用尽传统疗法的强迫症（OCD）患者有益。Nuttin等人发表了第一个针对强迫症的DBS系列，他们发现使用前连合吻侧直接延伸到相邻腹侧囊/腹侧纹状体（VC/VS）的囊靶点获得了有希望的结果。已发表的长期结局数据仅限于4例患者。在这项合作研究中，10名成年强迫症患者符合严格的严重程度和治疗阻力标准，在VC/VS双侧植入了四极刺激电极导线。DBS在3周后开放激活。8名患者已随访至少36个月。耶鲁-布朗强迫量表（YBOCS）评分从基线时的34.6 +/- 0.6（平均值+/- SEM）（重度）降至36个月时的22.3 +/- 2.1（中度）（p < 0.001）。在36个月时，8名患者中有4名患者的YBOCS严重程度下降>= 35%; 2名患者的评分下降25%至35%。总体功能评估评分从基线的36.6 +/- 1.5改善至36个月的53.8 +/- 2.5（p < 0.001）。抑郁和焦虑也有所改善，自我照顾，独立生活，工作，学校和社会功能也有所改善。手术不良反应包括无症状出血、单次癫痫发作和浅表感染。精神方面的不良反应包括短暂的轻躁狂症状，以及刺激器电池耗尽中断DBS时抑郁和强迫症恶化。这项开放性研究发现DBS在高度治疗抵抗性强迫症中具有良好的长期效果。
Deep brain stimulation ( DBS) of the anterior limb of the internal capsule has been shown to be beneficial in the short term for obsessive-compulsive disorder ( OCD) patients who exhaust conventional therapies. Nuttin et al, who published the first DBS for OCD series, found promising results using a capsule target immediately rostral to the anterior commissure extending into adjacent ventral capsule/ventral striatum ( VC/VS). Published long-term outcome data are limited to four patients. In this collaborative study, 10 adult OCD patients meeting stringent criteria for severity and treatment resistance had quadripolar stimulating leads implanted bilaterally in the VC/VS. DBS was activated openly 3 weeks later. Eight patients have been followed for at least 36 months. Group Yale-Brown Obsessive Compulsive Scale ( YBOCS) scores decreased from 34.6 +/- 0.6 ( mean +/- SEM) at baseline ( severe) to 22.3 +/- 2.1 ( moderate) at 36 months ( p < 0.001). Four of eight patients had a >= 35% decrease in YBOCS severity at 36 months; in two patients, scores declined between 25 and 35%. Global Assessment of Functioning scores improved from 36.6 +/- 1.5 at baseline to 53.8 +/- 2.5 at 36 months ( p < 0.001). Depression and anxiety also improved, as did self-care, independent living, and work, school, and social functioning. Surgical adverse effects included an asymptomatic hemorrhage, a single seizure, and a superficial infection. Psychiatric adverse effects included transient hypomanic symptoms, and worsened depression and OCD when DBS was interrupted by stimulator battery depletion. This open study found promising long-term effects of DBS in highly treatment-resistant OCD.