Kahn Lora, Sutton Brianne, Winston Helena R, Abosch Aviva, Thompson John A, Davis Rachel A
Department of Neurosurgery, Ochsner Health, Tulane University-Ochsner Health Neurosurgery Program, New Orleans, LA, United States.
Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, United States.
Front Psychiatry. 2021 Mar 24;12:568932. doi: 10.3389/fpsyt.2021.568932. eCollection 2021.
While case series have established the efficacy of deep brain stimulation (DBS) in treating obsessive-compulsive disorder (OCD), it has been our experience that few OCD patients present without comorbidities that affect outcomes associated with DBS treatment. Here we present our experience with DBS therapy for OCD in patients who all have comorbid disease, together with the results of our programming strategies. For this case series, we assessed five patients who underwent ventral capsule/ventral striatum (VC/VS) DBS for OCD between 2015 and 2019 at the University of Colorado Hospital. Every patient in this cohort exhibited comorbidities, including substance use disorders, eating disorder, tic disorder, and autism spectrum disorder. We conducted an IRB-approved, retrospective study of programming modifications and treatment response over the course of DBS therapy. In addition to patients' subjective reports of improvement, we observed significant improvement in the Yale-Brown Obsessive-Compulsive Scale (44%), the Montgomery-Asberg Depression Rating Scale (53%), the Quality of Life Enjoyment and Satisfaction Questionnaire (27%), and the Hamilton Anxiety Rating scales (34.9%) following DBS. With respect to co-morbid disease, there was a significant improvement in a patient with tic disorder's Total Tic Severity Score (TTSS) ( = 0.005). DBS remains an efficacious tool for the treatment of OCD, even in patients with significant comorbidities in whom DBS has not previously been investigated. Efficacious treatment results not only from the accurate placement of the electrodes by the surgeon but also from programming by the psychiatrist.
虽然病例系列研究已证实深部脑刺激（DBS）治疗强迫症（OCD）的有效性，但我们的经验是，很少有强迫症患者不存在影响DBS治疗效果的合并症。在此，我们介绍了对所有患有合并症的患者进行DBS治疗强迫症的经验，以及我们的程控策略结果。对于这个病例系列，我们评估了2015年至2019年在科罗拉多大学医院接受腹侧囊/腹侧纹状体（VC/VS）DBS治疗强迫症的5名患者。该队列中的每位患者都有合并症，包括物质使用障碍、饮食失调、抽动障碍和自闭症谱系障碍。我们进行了一项经机构审查委员会批准的关于DBS治疗过程中程控调整和治疗反应的回顾性研究。除了患者关于病情改善的主观报告外，我们观察到DBS治疗后耶鲁-布朗强迫症量表（改善44%）、蒙哥马利-阿斯伯格抑郁评定量表（改善53%）、生活享受与满意度问卷（改善27%）和汉密尔顿焦虑评定量表（改善34.9%）都有显著改善。关于合并症，一名患有抽动障碍的患者的抽动严重程度总分（TTSS）有显著改善（P = 0.005）。DBS仍然是治疗强迫症的有效工具，即使是在之前未对DBS进行过研究的有显著合并症的患者中也是如此。有效的治疗结果不仅源于外科医生准确放置电极，还源于精神科医生的程控。
