Pilot Study of DBS for Treatment-Refractory OCD

描述：（由申请人提供）本申请是对PA-99- 134项精神健康干预研究探索/发展赠款。 该研究项目的长期目标是减少症状的严重程度， 提高重症和难治性高血压患者的生活质量 强迫症（OCD）。尽管药理学的进步 和行为疗法的强迫症，大量的患者未能 经过多年传统和实验性的改进， 干预措施。对于某些患者，立体定向神经外科手术（扣带回切开术 或前囊切开术）是剩下的唯一有希望的选择。可用 有证据表明，这些程序可能会带来持久的好处， 相对较少的副作用，在大多数强迫症患者的顽固性 疾病然而，这些消融技术对脑组织和 功能是不可逆的。最近，一个欧洲调查小组报告说， 在《柳叶刀》杂志上，四分之三的顽固性强迫症病例使用 双侧脑深部电刺激（DBS）的前肢的内部 胶囊由合格的精神神经外科团队独立确认 在它得到更广泛的使用之前至关重要;已经有迹象表明， 从互联网上，全国各地的许多中心都在追求它。 表面看起来很有吸引力，至少与其他神经外科手术相比是这样 替代品.虽然DBS和消融手术一样， 与消融技术不同，DBS具有罕见但严重的风险， 可调节且部分可逆。如果失败，设备可以关闭， 非活性电极通常留在原位，但没有永久性改变 神经元的功能很有可能。目前的项目旨在收集 关于慢性给药的有效性、安全性和耐受性的初步数据 电刺激（DBS）通过双侧植入电极在 “恶性”内囊前肢6例 治疗难治性强迫症，否则将是候选人消融 神经外科他们将在手术后随访两年。所有候选人 因为这个程序必须通过一个跨学科的内部审查 审查小组以及两名独立外部审查员。如果证明有效， DBS可能会取代消融性神经外科手术，但仍应被视为 在最严重和最棘手的情况下， 强迫症

DESCRIPTION: (provided by applicant) This application is in response to PA-99- 134 for Exploratory/Development Grants for Mental Health Intervention Research. The long-term goal of this research project is to reduce symptom severity and enhance quality of life for patients with severe and intractable obsessive-compulsive disorder (OCD). Despite advances in the pharmacological and behavioral therapies for OCD, a substantial number of patients fail to improve significantly following years of conventional as well as experimental interventions. For some patients, stereotactic neurosurgery (either cingulotomy or anterior capsulotomy) is the only promising option left. The available evidence suggests that these procedures may lead to enduring benefits and relatively few side effects in the majority of OCD patients with intractable disease. However, the effects of these ablative techniques on brain tissue and function are irreversible. Recently, a team of European investigators reported in the Lancet positive results in three of four intractable cases of OCD using bilateral deep brain stimulation (DBS) of the anterior limb of the internal capsule. Independent confirmation by a qualified psychiatric-neurosurgical team is crucial before it gains more widespread use; there are already indications from the Internet that numerous centers across the country are pursuing it. On the surface, it seems appealing, at least in contrast to other neurosurgical alternatives. Although DBS, like ablative surgery, is an invasive procedure with infrequent but serious risks, unlike ablative techniques, DBS is adjustable and partially reversible. If it fails, the device can be turned off, the inactive electrodes are usually left in place, but no permanent alteration in neuronal function is likely. The current project is designed to gather preliminary data on the effectiveness, safety, and tolerability of chronic electrical stimulation (DBS) via bilaterally implanted electrodes in the anterior limb of the internal capsules of six cases of 'malignant' treatment-refractory OCD that would otherwise be candidates for ablative neurosurgery. They will be followed for two years post surgery. All candidates for this procedure will have to pass review by an interdisciplinary internal review panel as well as two independent external reviewers. If shown effective, DBS might replace ablative neurosurgery, but should still be considered the intervention of last resort in the most profoundly ill and intractable cases of OCD.