Abelson James L, Curtis George C, Sagher Oren, Albucher Ronald C, Harrigan Mark, Taylor Stephan F, Martis Brian, Giordani Bruno
Department of Psychiatry, University of Michigan, Trauma, Stress and Anxiety Research Group, Ann Arbor, Michigan, USA.
Biol Psychiatry. 2005 Mar 1;57(5):510-6. doi: 10.1016/j.biopsych.2004.11.042.
Neurosurgery (anterior capsulotomy) has been beneficial to many patients with debilitating, refractory obsessive-compulsive disorder (OCD), but the irreversibility of the procedure is an important limitation to its use. Nondestructive, electrical stimulation (deep brain stimulation; DBS) has proven an effective alternative to ablative surgery for neurological indications, suggesting potential utility in place of capsulotomy for OCD.
The effects of DBS for OCD were examined in four patients in a short-term, blinded, on-off design and long-term, open follow-up. The patients had incapacitating illness, refractory to standard treatments. Hardware developed for movement disorder treatment was surgically implanted, with leads placed bilaterally in the anterior limbs of their internal capsules. Patients received stimulation in a randomized "on-off" sequence of four 3-week blocks. Ongoing, open stimulation was continued in consenting patients after the controlled trial.
Patients tolerated DBS well. Dramatic benefits to mood, anxiety, and OCD symptoms were seen in one patient during blinded study and open, long-term follow-up. A second patient showed moderate benefit during open follow-up.
It appears that DBS has potential value for treating refractory psychiatric disorders, but additional development work is needed before the procedure is utilized outside of carefully controlled research protocols.
神经外科手术（前囊切开术）对许多患有严重、难治性强迫症（OCD）的患者有益，但该手术的不可逆性是其应用的一个重要限制。非破坏性电刺激（深部脑刺激；DBS）已被证明是神经适应症消融手术的有效替代方法，提示其可能替代OCD的囊切开术。
采用短期、盲法、开-关设计及长期、开放随访，对4例患者进行DBS治疗OCD的疗效研究。这些患者患有严重疾病，对标准治疗无效。为治疗运动障碍而开发的硬件通过手术植入，电极双侧置于内囊前肢。患者按随机的“开-关”顺序接受4个为期3周的刺激阶段。在对照试验后，对同意继续治疗的患者进行持续的开放刺激。
患者对DBS耐受性良好。在盲法研究和开放、长期随访期间，1例患者的情绪、焦虑和OCD症状有显著改善。第2例患者在开放随访期间有中度改善。
DBS似乎对治疗难治性精神疾病有潜在价值，但在该手术应用于严格控制的研究方案之外之前，还需要进行更多的开发工作。
