Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review.
Deep brain stimulation for treatment-refractory obsessive compulsive disorder: a systematic review.
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DOI：
10.1186/s12888-014-0214-y
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发表时间：
2014-08-02
期刊：
影响因子：
4.4
通讯作者：
Kuhn J
中科院分区：
文献类型：
--
作者：
Kohl S;Schönherr DM;Luigjes J;Denys D;Mueller UJ;Lenartz D;Visser-Vandewalle V;Kuhn J
强迫症是所有精神疾病中致残率最高的疾病之一。尽管有可用的药物和心理治疗，但仍有约10%的患者受到严重影响，被认为是治疗难治的。对于其中一些患者，脑深部刺激提供了一种合适的治疗方法。本文的范围是回顾已发表的数据，并比较不同的目标结构及其有效性。PubMed搜索，最近一次更新是在2013年6月，使用了“脑深部刺激”和“强迫症”这两个词。共有25篇文献报道了治疗强迫症的5种脑深部刺激靶点结构：内囊前肢(5篇研究，14例)、伏隔核(8篇，37例)、腹囊/腹侧纹状体(4篇，29例)、丘脑下核(5篇，23例)和丘脑下脚(2篇，6例)。尽管存在解剖学上的多样性，但脑深部刺激治疗对前四个靶结构的应答率相似。丘脑下部脚深部脑刺激可导致较高的应答率，但由于极少数病例，对这些结果的解释必须谨慎。与程序和设备相关的不良事件以及与刺激或治疗相关的副作用相对较低。大多数与刺激相关的副作用都是短暂的，并且在刺激参数改变后会下降。脑深部刺激治疗难治性强迫症似乎是一种相对安全和有前途的治疗选择。然而，基于这些研究，无法确定更好的靶向结构。需要更多的研究来更好地了解行动机制和反应预测因素，这可能有助于为这些严重影响的强迫症患者开发更个性化的方法。
Obsessive-compulsive disorder is one of the most disabling of all psychiatric illnesses. Despite available pharmacological and psychotherapeutic treatments about 10% of patients remain severely affected and are considered treatment-refractory. For some of these patients deep brain stimulation offers an appropriate treatment method. The scope of this article is to review the published data and to compare different target structures and their effectiveness. PubMed search, last update June 2013, was conducted using the terms “deep brain stimulation” and “obsessive compulsive disorder”. In total 25 studies were found that reported five deep brain stimulation target structures to treat obsessive-compulsive disorder: the anterior limb of the internal capsule (five studies including 14 patients), nucleus accumbens (eight studies including 37 patients), ventral capsule/ventral striatum (four studies including 29 patients), subthalamic nucleus (five studies including 23 patients) and inferior thalamic peduncle (two studies including 6 patients). Despite the anatomical diversity, deep brain stimulation treatment results in similar response rates for the first four target structures. Inferior thalamic peduncle deep brain stimulation results in higher response rates but these results have to be interpreted with caution due to a very small number of cases. Procedure and device related adverse events are relatively low, as well as stimulation or therapy related side effects. Most stimulation related side effects are transient and decline after stimulation parameters have been changed. Deep brain stimulation in treatment-refractory obsessive-compulsive disorder seems to be a relatively safe and promising treatment option. However, based on these studies no superior target structure could be identified. More research is needed to better understand mechanisms of action and response predictors that may help to develop a more personalized approach for these severely affected obsessive compulsive patients.
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影响因子：
10.6
作者：
Goodman WK;Foote KD;Greenberg BD;Ricciuti N;Bauer R;Ward H;Shapira NA;Wu SS;Hill CL;Rasmussen SA;Okun MS
通讯作者：
Okun MS
影响因子：
7.6
作者：
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DOI：
10.1176/appi.neuropsych.12090226
发表时间：
2014-12-01
影响因子：
2.9
作者：
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通讯作者：
Rasmussen, Steven A.
影响因子：
4.8
作者：
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