PILOT STUDY OF DBS FOR TREATMENT-REFRACTORY OCD

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。这项研究项目的目标是减轻严重和顽固性强迫症(OCD)患者的症状严重程度，提高生活质量。尽管药物和行为疗法取得了进展，但经过多年的常规和实验干预后，相当数量的患者未能显著改善。对于一些患者来说，立体定向神经外科手术是唯一有希望的选择。现有证据表明，对于大多数患有难治性疾病的强迫症患者，这些程序可能会带来持久的好处和相对较少的副作用。然而，这些消融技术对脑组织和功能的影响是不可逆转的。一组欧洲调查人员报告了四例顽固性强迫症中的三例，使用内囊前肢的双侧脑深部刺激(DBS)获得了阳性结果。在它得到更广泛的使用之前，由合格的精神神经外科团队进行独立确认是至关重要的；已经有迹象表明，全国各地的许多中心都在研究它。虽然DBS和消融手术一样，是一种风险不大但不常见的侵入性手术，但与消融技术不同，DBS是可调节的和部分可逆的。目前的项目旨在收集有关慢性刺激(DBS)的有效性、安全性和耐受性的初步数据，这些数据是通过在6名患有难治性强迫症的患者的内囊前肢两侧植入电极来进行的，否则这些患者将成为消融性神经外科手术的候选对象。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The goal of this research project is to reduce symptom severity and enhance quality of life for subjects with severe and intractable obsessive-compulsive disorder (OCD). Despite advances in the pharmacological and behavioral therapies, a substantial number of patients fail to improve significantly following years of conventional as well as experimental interventions. For some patients, stereotactic neurosurgery 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. A team of European investigators reported 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 that numerous centers across the country are pursuing it. Although DBS, like ablative surgery, is an invasive procedure with infrequent but serious risks, unlike ablative techniques, DBS is adjustable and partially reversible. The current project is designed to gather preliminary data on the effectiveness, safety, and tolerability of chronic stimulation (DBS) via bilaterally implanted electrodes in the anterior limb of the internal capsules of 6 subjects with treatment-refractory OCD that would otherwise be candidates for ablative neurosurgery.