van Westen Maarten, Rietveld Erik, Bergfeld Isidoor O, de Koning Pelle, Vullink Nienke, Ooms Pieter, Graat Ilse, Liebrand Luka, van den Munckhof Pepijn, Schuurman Rick, Denys Damiaan
Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Meibergdreef, 9, Amsterdam, The Netherlands.
Department of Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, Meibergdreef, 9, Amsterdam, The Netherlands.
Neuromodulation. 2021 Feb;24(2):307-315. doi: 10.1111/ner.13243. Epub 2020 Jul 20.
Deep brain stimulation (DBS) is an innovative and effective treatment for patients with therapy-refractory obsessive-compulsive disorder (OCD). DBS offers unique opportunities for personalized care, but no guidelines on how to choose effective and safe stimulation parameters in patients with OCD are available. Our group gained relevant practical knowledge on DBS optimization by treating more than 80 OCD patients since 2005, the world's largest cohort. The article's objective is to share this experience.
We provide guiding principles for optimizing DBS stimulation parameters in OCD and discuss the neurobiological and clinical basis.
Adjustments in stimulation parameters are performed in a fixed order. First, electrode contact activation is determined by the position of the electrodes on postoperative imaging. Second, voltage and pulse width are increased stepwise, enlarging both the chance of symptom reduction and of inducing side effects. Clinical evaluation of adjustments in stimulation parameters needs to take into account: 1) the particular temporal sequence in which the various OCD symptoms and DBS side-effects change; 2) the lack of robust response predictors; 3) the limited sensitivity of the Yale-Brown Obsessive-Compulsive Scale to assess DBS-induced changes in OCD symptoms; and 4) a patient's fitness for additional cognitive-behavioral therapy (CBT).
Decision-making in stimulation parameter optimization needs to be sensitive to the particular time-courses on which various symptoms and side effects change.
脑深部电刺激术（DBS）是治疗难治性强迫症（OCD）患者的一种创新且有效的疗法。DBS为个性化治疗提供了独特的机会，但目前尚无关于如何为OCD患者选择有效且安全的刺激参数的指南。自2005年以来，我们团队通过治疗80多名OCD患者获得了有关DBS优化的相关实践知识，这是全球最大的队列。本文的目的是分享这一经验。
我们提供了优化OCD患者DBS刺激参数的指导原则，并讨论了神经生物学和临床基础。
刺激参数的调整按固定顺序进行。首先，通过术后成像上电极的位置确定电极触点激活情况。其次，逐步增加电压和脉冲宽度，这既增加了症状减轻的机会，也增加了诱发副作用的可能性。刺激参数调整的临床评估需要考虑：1）各种OCD症状和DBS副作用变化的特定时间顺序；2）缺乏可靠的反应预测指标；3）耶鲁-布朗强迫症量表评估DBS引起的OCD症状变化的敏感性有限；4）患者接受额外认知行为疗法（CBT）的适宜性。
刺激参数优化的决策需要对各种症状和副作用变化的特定时间进程敏感。
