Mi Kuanqing
Department of Neurosurgery, The Fifth People's Hospital of Jinan, Jinan, Shandong 250021, P.R. China.
Exp Ther Med. 2016 Oct;12(4):2371-2376. doi: 10.3892/etm.2016.3622. Epub 2016 Aug 25.
The multifactorial etiology of major affective disorders, such as major depression and bipolar disorder, poses a challenge for identification of effective treatments. In a substantial number of patients, psychopharmacologic treatment does not lead to effective continuous symptom relief. The use of deep brain stimulation (DBS) for treatment-resistant patients is an investigational approach that has recently produced promising results. The recent development of safer stereotaxic neurosurgery, and the combination with functional neuroimaging to map the affected brain circuits, have led to the investigation of DBS as a potential strategy to treat major mood disorders. Several independent clinical studies have recently shown that chronic DBS treatment leads to remission of symptoms in a high number of treatment-resistant patients for major depression and bipolar disorder. In conclusion, the existing proof-of-principle that DBS can be an effective intervention for treatment-resistant depression opens new avenues for treatment. However, multicenter, randomized and blind trials need to confirm efficacy and be approved after the most recent failures. Patient selection and surgical-related improvements are key issues that remain to be addressed to help deliver more precise and customized treatment.
重度情感障碍，如重度抑郁症和双相情感障碍，其多因素病因给有效治疗方法的识别带来了挑战。在相当多的患者中，心理药物治疗并不能持续有效地缓解症状。对于难治性患者，使用深部脑刺激（DBS）是一种正在研究的方法，最近已产生了有前景的结果。更安全的立体定向神经外科手术的最新发展，以及与功能神经成像相结合以绘制受影响的脑回路，促使人们对DBS作为治疗重度情绪障碍的潜在策略进行研究。最近几项独立的临床研究表明，慢性DBS治疗可使大量难治性重度抑郁症和双相情感障碍患者的症状得到缓解。总之，DBS可作为难治性抑郁症的有效干预措施这一现有原理证明为治疗开辟了新途径。然而，多中心、随机和盲法试验需要确认疗效，并且在最近的失败之后还需获得批准。患者选择和手术相关的改进是仍有待解决的关键问题，以帮助提供更精确和定制化的治疗。
