Kopell Brian Harris, Greenberg Benjamin, Rezai Ali R
Center for Neurological Restoration, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Clin Neurophysiol. 2004 Jan-Feb;21(1):51-67. doi: 10.1097/00004691-200401000-00007.
Over the last decade, deep brain stimulation (DBS) has revolutionized the practice of neurosurgery, particularly in the realm of movement disorders. It is no surprise that DBS is now being studied in the treatment of refractory psychiatric disease. Deep brain stimulation has inherent advantages over previous lesioning procedures. It is fully reversible, and stimulation can be adjusted according to a patient's changing symptoms and disease progression. Coupled with the fact that the stimulation can generally be turned on or off without the patient's awareness, DBS provides a unique opportunity for double-blinding studies. To undertake DBS for psychiatric conditions, appropriate surgical targets must be chosen. What is most strongly supported is the role of cortico-striato-thalamocortical (CSTC) loops in the pathophysiology of psychiatric symptoms. Recent functional imaging studies have consistently found evidence that corroborate this model of psychiatric symptom pathogenesis. Based on the psychiatric and cognitive effects seen in recent movement disorder surgery, it is apparent that modulation of neural systems subserving psychiatric phenomenon can be accomplished by DBS. The few published studies on DBS for obsessive-compulsive disorder (OCD) suggest that this can be done safely. While efficacy data are still uncertain, initial data are promising.
在过去十年中，深部脑刺激（DBS）彻底改变了神经外科手术的实践，尤其是在运动障碍领域。如今DBS正在被用于难治性精神疾病的治疗，这并不奇怪。与之前的毁损手术相比，深部脑刺激具有内在优势。它是完全可逆的，并且刺激可以根据患者不断变化的症状和疾病进展进行调整。再加上刺激通常可以在患者不知情的情况下开启或关闭，DBS为双盲研究提供了独特的机会。要对精神疾病进行DBS治疗，必须选择合适的手术靶点。最有力的支持是皮质-纹状体-丘脑-皮质（CSTC）环路在精神症状病理生理学中的作用。最近的功能成像研究一直发现证据支持这种精神症状发病机制模型。基于近期运动障碍手术中观察到的精神和认知效应，很明显通过DBS可以实现对介导精神现象的神经系统的调节。少数关于DBS治疗强迫症（OCD）的已发表研究表明，这样做是安全的。虽然疗效数据仍不确定，但初步数据很有前景。
