DEEP BRAIN STIMULATION FOR REFRACTORY OBSESSIVE COMPULSIVE DISORDER

脑深部刺激治疗难治性强迫症

• 批准号: 6303489
• 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: 1999
• 资助国家: 美国
• 起止时间: 1999-12-01 至 2001-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6303489
• 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.

大脑内囊前肢的小面积手术破坏（病变）（前囊切开术）已被证明对许多尽管接受常规治疗但仍患有强迫症（OCD）的患者有帮助。 事实证明，大脑不同位置（丘脑腹侧中间核）的病变对药物无反应的震颤（无法控制的颤抖）有益。 对于震颤，通过植入丘脑的电极进行慢性电刺激（脑深部电刺激，DBS）已被证明与损伤一样有效，因此不必破坏脑组织。 这表明，在治疗强迫症时，通过内囊前肢的电极进行慢性刺激可能会取代前囊切开术。 我们现在建议进行一项试验性研究，以调查情况是否如此。 如果是这样的话，出于多种原因，慢性电刺激将是优选的。 我们还建议使用正电子发射断层扫描（PET）与[18 F]氟脱氧葡萄糖（FDG），以确定哪些区域的大脑被激活的电刺激在这部分内囊。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名常规治疗难治性强迫症患者，否则他们将是前囊切开术的候选者。在诊断和基线研究后，通过精确的立体定向技术将电极放置在每个内囊的前肢中，并连接到植入皮肤下的电脉冲发生器。手术后，将在医院内对DBS系统进行测试，以评估副作用和并发症，确定可能的即时治疗效果，并寻找最佳刺激设置。 随后，作为门诊患者，每名患者将经历几周的时间，其中刺激将在双盲设计中交替打开和关闭，以验证任何明显的益处并测试延长刺激的可能益处。 将在每个阶段评估症状严重程度和损伤评分。 在研究完成时，患者可以选择继续刺激、前囊切开术或进一步的常规治疗。