Lakhan Shaheen E, Callaway Enoch
Global Neuroscience Initiative Foundation, Los Angeles, CA, USA.
BMC Res Notes. 2010 Mar 4;3:60. doi: 10.1186/1756-0500-3-60.
In spite of advances in psychotherapy and pharmacotherapy, there are still a significant number of patients with depression and obsessive-compulsive disorder that are not aided by either intervention. Although still in the experimental stage, deep brain stimulation (DBS) offers many advantages over other physically-invasive procedures as a treatment for these psychiatric disorders. The purpose of this study is to systematically review reports on clinical trials of DBS for obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Locations for stimulation, success rates and effects of the stimulation on brain metabolism are noted when available. The first observation of the effects of DBS on OCD and TRD came in the course of using DBS to treat movement disorders. Reports of changes in OCD and depression during such studies are reviewed with particular attention to electrode locations and associated adverse events; although these reports were adventitious observations rather than planned. Subsequent studies have been guided by more precise theories of structures involved in DBS and OICD. This study suggests stimulation sites and prognostic indicators for DBS. We also briefly review tractography, a relatively new procedure that holds great promise for the further development of DBS.
Articles were retrieved from MEDLINE via PubMed. Relevant references in retrieved articles were followed up. We included all articles reporting on studies of patients selected for having OCD or TRD. Adequacy of the selected studies was evaluated by the Jadad scale. Evaluation criteria included: number of patients, use of recognized psychiatric rating scales, and use of brain blood flow measurements. Success rates classified as "improved" or "recovered" were recorded. Studies of DBS for movement disorders were included if they reported coincidental relief of depression or reduction in OCD. Most of the studies involved small numbers of subjects so individual studies were reviewed.
While the number of cases was small, these were extremely treatment-resistant patients. While not everyone responded, about half the patients did show dramatic improvement. Associated adverse events were generally trivial in younger psychiatric patients but often severe in older movement disorder patients. The procedures differed from study to study, and the numbers of patients was usually too small to do meaningful statistics or make valid inferences as to who will respond to treatment.
DBS is considered a promising technique for OCD and TRD. Outstanding questions about patient selection and electrode placement can probably be resolved by (a) larger studies, (b) genetic studies and (c) imaging studies (MRI, fMRI, PET, and tractography).
尽管心理治疗和药物治疗取得了进展，但仍有相当数量的抑郁症和强迫症患者无法从这两种治疗中得到帮助。深部脑刺激（DBS）虽然仍处于实验阶段，但作为治疗这些精神疾病的方法，它比其他有创治疗具有许多优势。本研究的目的是系统回顾关于DBS治疗强迫症（OCD）和难治性抑郁症（TRD）的临床试验报告。如有可用信息，记录刺激部位、成功率以及刺激对脑代谢的影响。DBS对OCD和TRD影响的首次观察是在使用DBS治疗运动障碍的过程中出现的。在此类研究中关于OCD和抑郁症变化的报告进行了回顾，特别关注电极位置和相关不良事件；尽管这些报告是偶然观察而非计划好的。后续研究受到关于DBS和OCD所涉及结构的更精确理论的指导。本研究提出了DBS的刺激部位和预后指标。我们还简要回顾了纤维束成像，这是一种相对较新的技术，对DBS的进一步发展具有很大潜力。
通过PubMed从MEDLINE检索文章。对检索到的文章中的相关参考文献进行追踪。我们纳入了所有报告对被选为患有OCD或TRD患者进行研究的文章。所选研究的充分性通过Jadad量表进行评估。评估标准包括：患者数量、是否使用公认的精神科评定量表以及是否使用脑血流测量。记录分类为“改善”或“康复”的成功率。如果关于DBS治疗运动障碍的研究报告了抑郁症的巧合缓解或OCD的减轻，则将其纳入。大多数研究涉及的受试者数量较少，因此对个别研究进行了回顾。
虽然病例数量较少，但这些都是极具治疗抵抗性的患者。并非所有人都有反应，但约一半的患者确实显示出显著改善。相关不良事件在年轻精神科患者中通常较轻，但在老年运动障碍患者中往往较为严重。不同研究的操作方法不同，而且患者数量通常太少，无法进行有意义的统计或对谁会对治疗有反应做出有效推断。
DBS被认为是治疗OCD和TRD的一种有前景的技术。关于患者选择和电极放置的突出问题可能可以通过（a）更大规模的研究、（b）基因研究和（c）成像研究（MRI、fMRI、PET和纤维束成像）来解决。
