Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Sant Antoni M. Claret, Barcelona, Catalonia, Spain.
Int J Neuropsychopharmacol. 2012 Feb;15(1):121-33. doi: 10.1017/S1461145711001088. Epub 2011 Jul 22.
Deep brain stimulation (DBS) is currently tested as an experimental therapy for patients with treatment-resistant depression (TRD). Here we report on the short- and long-term (1 yr) clinical outcomes and tolerance of DBS in eight TRD patients. Electrodes were implanted bilaterally in the subgenual cingulate gyrus (SCG; Broadman areas 24-25), and stimulated at 135 Hz (90-μs pulsewidth). Voltage and active electrode contacts were adjusted to maximize short-term responses. Clinical assessments included the 17-item Hamilton Depression Rating Scale (HAMD17; primary measure), the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) Scale. In the first week after surgery, response and remission (HAMD ⩽7) rates were, respectively 87.5% and 50%. These early responses were followed by an overall worsening, with a response and remission rates of 37.5% (3/8) at 1 month. From then onwards, patients showed a progressive improvement, with response and remission rates of 87.5% and 37.5%, respectively, at 6 months. The corresponding figures at 1 yr were 62.5% and 50%, respectively. Clinical effects were seen in all HAMD subscales without a significant incidence of side-effects. Surgical procedure and post-operative period were well-tolerated for all patients. This is the second independent study on the use of DBS of the SCG to treat chronic depression resistant to current therapeutic strategies. DBS fully remitted 50% of the patients at 1 yr, supporting its validity as a new therapeutic strategy for TRD.
深部脑刺激（DBS）目前正在作为一种治疗抵抗性抑郁症（TRD）患者的实验疗法进行测试。在这里，我们报告了 8 名 TRD 患者的 DBS 的短期和长期（1 年）临床结果和耐受性。电极双侧植入扣带回下（SCG；Broadman 区 24-25），以 135 Hz（90-μs 脉冲宽度）刺激。调整电压和活动电极接触以最大限度地提高短期反应。临床评估包括 17 项汉密尔顿抑郁评定量表（HAMD17；主要测量指标）、蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和临床总体印象（CGI）量表。在手术后的第一周，反应和缓解（HAMD ⩽7）的比例分别为 87.5%和 50%。这些早期反应之后是整体恶化，1 个月时的反应和缓解率分别为 37.5%（8 例中有 3 例）。从那时起，患者表现出逐渐改善，6 个月时的反应和缓解率分别为 87.5%和 37.5%。相应的 1 年数据分别为 62.5%和 50%。所有 HAMD 子量表都显示出临床效果，没有明显的副作用发生率。所有患者的手术过程和术后阶段都得到了很好的耐受。这是第二项关于使用 SCG 的 DBS 治疗对现有治疗策略有抵抗的慢性抑郁症的独立研究。DBS 在 1 年内完全缓解了 50%的患者，支持其作为 TRD 的新治疗策略的有效性。
