Vázquez-Bourgon Javier, Martino Juan, Sierra Peña María, Infante Ceberio Jon, Martínez Martínez M Ángeles, Ocón Roberto, Menchón José Manuel, Crespo Facorro Benedicto, Vázquez-Barquero Alfonso
Servicio de Psiquiatría, Hospital Universitario Marqués de Valdecilla, IDIVAL, Universidad de Cantabria, Centro de Investigación en Red de Salud Mental (CIBERSAM), Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España.
Servicio de Neurocirugía, Hospital Universitario Marqués de Valdecilla, Santander, España; Unidad de Estimulación Cerebral Profunda, Hospital Universitario Marqués de Valdecilla, Santander, España.
Rev Psiquiatr Salud Ment (Engl Ed). 2019 Jan-Mar;12(1):37-51. doi: 10.1016/j.rpsm.2017.05.005. Epub 2017 Jul 1.
At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD.
We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words 'Deep brain stimulation', 'DBS' and 'Obsessive-compulsive disorder' 'OCS'. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed.
The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualize the decision of continuing with concomitant psychopharmacological and psychological treatments.
The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.
至少10%的强迫症（OCD）患者对心理药物治疗无效。神经外科中用于调节神经元活动改变的新技术——深部脑刺激（DBS），已使其能够用于治疗严重且难治的强迫症病例。本文的目的是回顾当前关于该技术对难治性强迫症的有效性和适用性的科学证据。
我们系统地回顾了文献，以确定深部脑刺激的主要特征、其作为强迫症治疗方法的使用情况和适用性。因此，我们检索了PubMed/Medline、Embase和PsycINFO数据库，组合关键词“深部脑刺激”“DBS”以及“强迫症”“OCD”。文章由两位作者根据摘要独立筛选，如果文章描述了该疗法与强迫症相关的任何主要特征：适用性；作用机制；脑治疗靶点；疗效；副作用；联合治疗。随后提取并分析了所有信息。
对证据的批判性分析表明，在治疗难治性强迫症中使用DBS在疗效方面提供了令人满意的结果，且副作用在可接受范围内。然而，没有足够的证据支持使用某一个脑靶点优于另一个。必须在分析风险/益处后进行患者选择，建议个体化决定是否继续同时进行心理药物治疗和心理治疗。
尽管DBS在难治性强迫症中的应用越来越多，并且在大多数研究中使症状、功能和生活质量有显著改善，但DBS的使用仍被认为处于研究领域。开展关于其长期疗效、成本-风险分析和成本/效益的随机对照研究至关重要。
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