Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, Amsterdam, the Netherlands.
Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands.
Brain Stimul. 2022 Jul-Aug;15(4):957-964. doi: 10.1016/j.brs.2022.06.010. Epub 2022 Jun 27.
Given the invasiveness of deep brain stimulation (DBS), the effect should prove to be stable over the long-term and translate into an improvement of quality of life (QOL).
To study the effectiveness and QOL up to nine years after the DBS surgery.
We treated 25 adult patients with major depression with DBS of the ventral anterior limb of the internal capsule (vALIC). We followed them up naturalistically for 6-9 years after surgery (mean: 7.7 [SD:1.5] years), including a randomized crossover phase after the first year comparing sham with active DBS. Symptom severity was quantified using the Hamilton Depression Scale with response defined as a ≥50% decrease of the score compared to baseline. Quality of life was measured using the WHOQOL-BREF, assessing 5 domains (general, physical, psychological, social, environmental).
Intention-to-treat response rates remained mostly stable from Year 3 to last follow-up (Year 3, 5 and 6: 40%; Year 4: 36%; Last observation: 44%). General, physical, psychological (all P < 0.001) and the environmental (P = 0.02) domain scores increased during DBS optimization and remained stable over the long term. No statistically significant changes were detected on the social domain. Patients scored significantly higher during active than sham DBS on the psychological, social and environmental domains, and trended towards a higher score on the general and physical domains.
This study shows continued efficacy of vALIC DBS in depression, which translates into an improvement of QOL providing further support for DBS as a durable treatment for TRD.
鉴于脑深部电刺激（DBS）的侵袭性，其效果应该长期稳定，并转化为生活质量（QOL）的改善。
研究 DBS 手术后长达 9 年的疗效和 QOL。
我们对 25 名成年重度抑郁症患者进行了腹侧前肢内囊（vALIC）的 DBS 治疗。我们对他们进行了自然随访，术后 6-9 年（平均：7.7 [SD：1.5] 年），包括第一年的随机交叉期，比较假刺激与真刺激 DBS。采用汉密尔顿抑郁量表（Hamilton Depression Scale）量化症状严重程度，以与基线相比评分下降≥50%定义为有反应。使用世界卫生组织生活质量简表（WHOQOL-BREF）评估 5 个领域（一般、身体、心理、社会、环境）的生活质量。
意向治疗反应率从第 3 年到最后随访（第 3 年、第 5 年和第 6 年：40%；第 4 年：36%；最后观察：44%）基本保持稳定。一般、身体、心理（均 P < 0.001）和环境（P = 0.02）领域的评分在 DBS 优化过程中增加，并在长期内保持稳定。社会领域未检测到统计学上的显著变化。在心理、社会和环境领域，患者在真刺激 DBS 时的评分明显高于假刺激 DBS，在一般和身体领域的评分也有升高趋势。
本研究显示 vALIC DBS 在抑郁症中的持续疗效，转化为 QOL 的改善，进一步支持 DBS 作为 TRD 的一种持久治疗方法。
