Unit of Stereotactic, Functional Neurosurgery and Radiosurgery, General Hospital of Mexico, Mexico City, Mexico.
Neurosurgery. 2009 Dec;65(6 Suppl):203-9; discussion 209. doi: 10.1227/01.NEU.0000345938.39199.90.
Deep brain stimulation has been used in the treatment of refractory obsessive-compulsive disorder (OCD). Our principal objective was to determine the safety and effectiveness of deep brain stimulation of the inferior thalamic peduncle in the treatment of refractory OCD.
An open protocol was performed from March 2003 to April 2007 in 5 patients with OCD refractory to conventional treatments. Bilateral stereotactic implantation of tetrapolar electrodes was aimed at the inferior thalamic peduncle and corroborated by electrophysiological responses and magnetic resonance imaging. All patients were off stimulation for 1 month after implantation. In the on-stimulation period, parameters were set at 5 V, 450 microseconds, 130 Hz in bipolar and continuous mode. Clinical changes were evaluated every 3 months for 12 months by means of the Yale-Brown Obsessive Compulsive Scale and the Global Assessment of Functioning scale. Statistical significance was assessed by the Friedman and Wilcoxon tests.
The mean Yale-Brown Obsessive Compulsive Scale score decreased from 35 to 17.8 (P < 0.001), and the mean Global Assessment of Functioning scale score improved from 20% to 70% (P < 0.0001). The neuropsychological battery did not show significant changes, and there were no side effects related to electrical stimulation in the chronic period.
We conclude that inferior thalamic peduncle stimulation is a safe procedure and may be an effective alternative in the treatment of those OCD cases refractory to conventional treatments.
深部脑刺激已用于治疗难治性强迫症（OCD）。我们的主要目标是确定刺激内苍白球下脚治疗难治性 OCD 的安全性和有效性。
2003 年 3 月至 2007 年 4 月，对 5 例常规治疗无效的 OCD 患者进行开放性方案研究。双侧立体定向植入四极电极，目标是内苍白球下脚，并通过电生理反应和磁共振成像进行证实。所有患者在植入后 1 个月均停止刺激。在刺激期间，参数设置为双极、连续模式，5 V、450 微秒、130 Hz。在 12 个月的时间里，每隔 3 个月通过耶鲁-布朗强迫症量表和总体功能评估量表评估临床变化。统计意义通过 Friedman 和 Wilcoxon 检验评估。
耶鲁-布朗强迫症量表评分从 35 分降至 17.8 分（P < 0.001），总体功能评估量表评分从 20%提高至 70%（P < 0.0001）。神经心理学测试套件未显示出显著变化，在慢性期也没有与电刺激相关的副作用。
我们得出结论，刺激内苍白球下脚是一种安全的程序，可能是治疗常规治疗无效的 OCD 病例的有效替代方法。
