DEEP BRAIN STIMULATION FOR REFRACTORY OBSESSIVE COMPULSIVE DISORDER

脑深部刺激治疗难治性强迫症

• 批准号: 6297059
• 负责人: GEORGE C CURTIS
• 金额: $ 0.02万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-12-01 至 1999-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6297059
• 关键词: clinical research; electrostimulus; human subject; human therapy evaluation; obsessive compulsive disorder; outcomes research; psychotherapy; stereotaxic techniques

Small areas of surgical destruction (lesions) in the anterior limb of the internal capsule of the brain (anterior capsulotomy) have proved helpful for many patients who remain disabled with Obsessive Compulsive Disorder (OCD) in spite of conventional therapies. Lesions in a different brain location, the nucleus ventralis intermedius of the thalamus, have proved beneficial for tremors (uncontrollable shaking) which do not respond to medication. For tremors, chronic electrical simulation through electrodes implanted in the thalamus (deep brain stimulation, or DBS) has proved as effective as lesions, making it unnecessary to destroy brain tissue. This suggests that chronic stimulation through electrodes in the anterior limb of the internal capsule might substitute for anterior capsulotomy in the treatment of OCD. We now propose a pilot study to investigate whether this may be the case. If so, chronic electrical stimulation would be preferable for a number of reasons. We also propose to use scanning by positron emission tomography (PET) with [18F] fluorodeoxyglucose (FDG) to determine which areas of the brain are activated by electrical stimulation in this portion of the internal capsule. This will provide basic information on brain connections and function and may provide clues to the brain mechanisms of OCD. Subjects will be five patients with OCD refractory to conventional therapies, who would otherwise be candidates for anterior capsulotomy. After diagnostic and baseline studies, electrodes will be placed in the anterior limbs of each internal capsule by precise stereotactic technique and connected to electrical pulse generators implanted under the skin. After surgery the DBS system will be tested in-hospital to assess for side effects and complications, to identify possible immediate therapeutic effects, and to search for optimum stimulation settings. Subsequently, as outpatients, each patient will undergo periods of several weeks each, in which stimulation will alternately be turned on and off in a double blind design in order to verify any apparent benefits and to test for possible benefits of prolonged stimulation. Symptom severity and impairment scores will be assessed during each period. At the completion of the study, patients will be given the choice of continued stimulation, anterior capsulotomy, or further conventional therapy.

在大脑内囊前肢的小范围外科破坏(病变)(前囊切开术)已被证明对许多尽管采用传统治疗仍有残疾的强迫症(OCD)患者有帮助。在不同的大脑位置，丘脑腹侧中间核的损害，已被证明对对药物无效的震颤(无法控制的颤抖)有益。对于震颤，通过在丘脑植入电极的慢性电模拟(脑深部刺激，或DBS)已被证明与损伤一样有效，使其没有必要破坏脑组织。提示内囊前肢电极慢性刺激可替代前囊切开术治疗强迫症。我们现在建议进行一项试点研究，以调查情况是否属实。如果是这样的话，出于几个原因，慢性电刺激将是更可取的。我们还建议使用[18F]氟脱氧葡萄糖(FDG)的正电子发射断层扫描(PET)来确定内囊这一部分的电刺激激活了大脑的哪些区域。这将提供有关大脑连接和功能的基本信息，并可能为强迫症的大脑机制提供线索。受试者将是5名对传统疗法无效的强迫症患者，否则他们将成为前囊膜切开术的候选对象。在诊断和基线研究之后，电极将通过精确的立体定向技术放置在每个内囊的前肢，并连接到植入皮肤下的电脉冲发生器。手术后，DBS系统将在医院内进行测试，以评估副作用和并发症，确定可能的即时治疗效果，并寻找最佳刺激环境。随后，作为门诊患者，每个患者都将经历几周的时间，在此期间，刺激将以双盲设计交替打开和关闭，以验证任何明显的好处，并测试长期刺激的可能好处。症状严重程度和损伤评分将在每个阶段进行评估。在研究完成时，患者将被给予继续刺激、前囊膜切开术或进一步常规治疗的选择。