Combined bilateral anterior cingulotomy and ventral capsule/ventral striatum deep brain stimulation for refractory obsessive-compulsive disorder with major depression: Do combined procedures have a long-term benefit?
Combined bilateral anterior cingulotomy and ventral capsule/ventral striatum deep brain stimulation for refractory obsessive-compulsive disorder with major depression: Do combined procedures have a long-term benefit?
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DOI：
10.3233/rnn-120290
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发表时间：
2013-01-01
影响因子：
2.8
通讯作者：
Chang, Jin Woo
中科院分区：
文献类型：
--
作者：
Chang, Won Seok;Roh, Daeyoung;Chang, Jin Woo
背景资料：腹侧囊（VC）、腹侧纹状体（VS）和前扣带回是强迫症（OCD）和抑郁回路的一部分。我们评估了双侧前扣带回切开术和VC/VS脑深部电刺激（DBS）的组合是否有一个附加的效果，在强迫症和抑郁症患者。方法：三名难治性强迫症患者进行了联合双侧前扣带回切开术和VC/VS DBS程序。所有患者均符合韩国DBS治疗强迫症指南的入选标准。评估基线Yale-Brown强迫症量表（Y-BOCS）评分、汉密尔顿抑郁评定量表评分和总体功能评估。结果：术前Y-BOCS评分平均值为34.7分（范围30-38分），术后3个月Y-BOCS评分显著下降至23.0分（范围20-25分）。该评分在术后2年保持在平均值19.0（范围18-20）。结论：两种疗法的组合并没有产生上级结果，因为其临床结果与以前单独使用VC/VS DBS的报告相当。大面积VC/VS DBS可能足以控制难治性强迫症。
Background: The ventral capsule (VC), ventral striatum (VS), and the anterior cingulate gyrus are parts of the obsessive-compulsive disorder (OCD) and depression circuits. We assessed whether a combination of bilateral anterior cingulotomy and VC/VS deep brain stimulation (DBS) had an additive effect in patients with OCD and major depression.Methods: Three patients with refractory OCD underwent combined bilateral anterior cingulotomy and VC/VS DBS procedures. All patients met the inclusion criteria for the Korean guidelines of DBS for OCD. Baseline Yale-Brown Obsessive-Compulsive Disorder Scale (Y-BOCS) scores, Hamilton Depression Rating Scale scores, and global assessments of functioning were evaluated. These scores were also serially estimated for more than 24 months after surgery at 3-month intervals.Results: The mean value of the baseline Y-BOCS scores was 34.7 (range 30-38); the mean Y-BOCS value decreased significantly to 23.0 (range 20-25) 3 months after the surgery. This score was maintained 2 years after surgery with a mean value of 19.0 (range 18-20).Conclusions: The combination of the two therapies did not yield superior outcomes, as the clinical outcomes were comparable to those of previous reports for VC/VS DBS alone. Wide-area VC/VS DBS may be sufficient to control refractory OCD.