Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France.
Biol Psychiatry. 2010 Dec 1;68(11):1016-22. doi: 10.1016/j.biopsych.2010.06.033. Epub 2010 Oct 16.
High-frequency bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is a promising treatment in refractory obsessive-compulsive disorder (OCD).
Using the crossover, randomized, and double-blind procedure adopted by the STOC study, 10 patients treated with high-frequency bilateral STN DBS underwent am 18-fluorodeoxyglucose positron emission tomography (PET) investigation to highlight the neural substratum of this therapeutic approach.
The median Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores for all 10 patients were 31 (minimum = 18, maximum = 36) with "Off-Stimulation" status and 19 (minimum = 0, maximum = 30) with "On-Stimulation" status (p = .05). The OCD patients in Off-Stimulation status showed a hypermetabolism in the right frontal middle and superior gyri, right parietal lobe, postcentral gyrus, and bilateral putamen compared with healthy control subjects. A significant decrease in cerebral metabolism was observed in the left cingulate gyrus and the left frontal medial gyrus in On-Stimulation conditions compared with Off-Stimulation conditions. In addition, the improvement assessed by Y-BOCS scores during the On-Stimulation conditions was positively correlated with PET signal changes at the boundary of the orbitofrontal cortex and the medial prefrontal cortex, between PET signal changes and the Y-BOCS scores modifications in On-Stimulation status.
This study suggests that the therapeutic effect of STN DBS is related to a decrease in prefrontal cortex metabolism.
高频双侧丘脑底核（STN）深部脑刺激（DBS）是一种治疗难治性强迫症（OCD）的有前途的方法。
采用 STOC 研究采用的交叉、随机、双盲程序，对 10 例接受高频双侧 STN DBS 治疗的患者进行了 18-氟脱氧葡萄糖正电子发射断层扫描（PET）检查，以突出这种治疗方法的神经基础。
10 例患者的耶鲁-布朗强迫症量表（Y-BOCS）评分中位数均为 31（最小值=18，最大值=36），处于“关刺激”状态，19（最小值=0，最大值=30）处于“开刺激”状态（p=0.05）。与健康对照组相比，处于“关刺激”状态的 OCD 患者右侧额中回和上回、右侧顶叶、中央后回和双侧壳核代谢亢进。与“关刺激”状态相比，“开刺激”状态下左扣带回和左额内侧回的大脑代谢明显下降。此外，“开刺激”状态下 Y-BOCS 评分的改善与眶额皮质和内侧前额叶边界的 PET 信号变化呈正相关，与“开刺激”状态下的 Y-BOCS 评分改变的 PET 信号变化呈正相关。
这项研究表明，STN DBS 的治疗效果与前额叶皮质代谢的降低有关。
