Schlaepfer T E, Bewernick B H
Brain Stimulation Group, Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany; Departments of Psychiatry and Mental Health, Johns Hopkins University, Baltimore, MD, USA.
Handb Clin Neurol. 2013;116:235-43. doi: 10.1016/B978-0-444-53497-2.00018-8.
A third of patients suffering from major depression cannot be helped by conventional treatment methods. These patients face reduced quality of life, high risk of suicide, and little hope of recovery. Deep brain stimulation (DBS) is under scientific evaluation as a new treatment option for these treatment-resistant patients. First clinical studies with small samples have been stimulated at the subgenual cingulate gyrus (Cg25/24), the anterior limb of the capsula interna (ALIC), and the nucleus accumbens (NAcc). Long-term antidepressant effects, augmentation of social functioning, and normalization of brain metabolism have been shown in about 50% of patients. Cognitive safety regarding attention, learning, and memory has been reported. Adverse events were wound infection, suicide, and hypomania, amongst others. Larger studies are under way to confirm these preliminary encouraging results. New hypothesis-guided targets (e.g., medial forebrain bundle, habenula) are about to be assessed in clinical trials. The application of DBS for other psychiatric diseases (e.g., bipolar disorder, alcohol dependency, opioid addiction, schizophrenia) is debated and single case studies are under way. Standards are needed for study registration, target selection, patient inclusion and monitoring, and publication of results to guarantee safety for the patients and scientific exchange.
三分之一的重度抑郁症患者无法通过传统治疗方法得到缓解。这些患者面临生活质量下降、自杀风险高以及康复希望渺茫的问题。深部脑刺激（DBS）作为一种针对这些难治性患者的新治疗选择正在接受科学评估。最初的小样本临床研究刺激的靶点是膝下扣带回（Cg25/24）、内囊前肢（ALIC）和伏隔核（NAcc）。约50%的患者显示出长期抗抑郁效果、社交功能增强以及脑代谢正常化。关于注意力、学习和记忆的认知安全性也有报告。不良事件包括伤口感染、自杀和轻躁狂等。正在进行更大规模的研究以证实这些初步的鼓舞人心的结果。新的基于假设的靶点（如内侧前脑束、缰核）即将在临床试验中进行评估。DBS在其他精神疾病（如双相情感障碍、酒精依赖、阿片类成瘾、精神分裂症）中的应用存在争议，目前正在进行单病例研究。需要制定研究注册、靶点选择、患者纳入与监测以及结果发表的标准，以确保患者安全和科学交流。
