Islam Lucrezia, Franzini Angelo, Messina Giuseppe, Scarone Silvio, Gambini Orsola
Department of Psychiatry, University of Milan Medical School, Ospedale San Paolo, Milan, Italy.
Department of Neurosurgery, Istituto Neurologico Carlo Besta, Milan, Italy.
World Neurosurg. 2015 Apr;83(4):657-63. doi: 10.1016/j.wneu.2014.12.024. Epub 2014 Dec 18.
Obsessive-compulsive disorder (OCD) is a psychiatric condition defined by the presence of obsessions, compulsions, or both. It has a lifetime prevalence of 2%-3% and causes significant impairment in social and work functioning, as well as a reduced quality of life. Treatment includes pharmacotherapy and psychotherapy, but a significant number of patients fail to respond to treatment. Deep brain stimulation has shown to be a safe and effective procedure for severe, chronic, treatment-resistant OCD, and several surgical targets have been proposed for treatment, including the nucleus accumbens, the anterior limb of the internal capsule, the subthalamic nucleus, the globus pallidus, and the bed nucleus of stria terminalis.
To report the first Italian case series of patients who underwent DBS of 2 distinct targets for OCD: nulceus accumbens and bed nulceus of stria terminalis.
Four patients underwent DBS of the nulceus accumbens, and 4 patients underwent DBS of the bed nucleus of stria terminalis.
Six patients showed a significant improvement in OCD symptoms.
DBS of these 2 structures is a safe and effective procedure for the treatment of severe, refractory OCD.
强迫症（OCD）是一种精神疾病，其特征为存在强迫观念、强迫行为或两者皆有。其终生患病率为2%-3%，会对社交和工作功能造成严重损害，并降低生活质量。治疗方法包括药物治疗和心理治疗，但相当一部分患者对治疗无反应。对于严重、慢性、难治性强迫症，脑深部电刺激已被证明是一种安全有效的治疗方法，并且已经提出了几个用于治疗的手术靶点，包括伏隔核、内囊前肢、丘脑底核、苍白球和终纹床核。
报告首例意大利患者系列，这些患者因强迫症接受了针对两个不同靶点（伏隔核和终纹床核）的脑深部电刺激治疗。
4例患者接受了伏隔核脑深部电刺激治疗，4例患者接受了终纹床核脑深部电刺激治疗。
6例患者的强迫症症状有显著改善。
对这两个结构进行脑深部电刺激是治疗严重难治性强迫症的一种安全有效的方法。
