Münchenberg Pauline Sarah, Joyce Eileen M, Matthews Keith, Christmas David, Zrinzo Ludvic
Department of Clinical & Motor Neurosciences, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK.
Advanced Interventions Service, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
Brain Sci. 2022 Oct 12;12(10):1379. doi: 10.3390/brainsci12101379.
(1) Background: Major depressive disorder (MDD) generates a large proportion of global disease burden. Stereotactic radiofrequency ablation (SRA) may be beneficial for selected patients with its most debilitating and refractory forms, but effect size is uncertain. (2) Methods: A systematic literature review and meta-analysis on SRA for MDD was carried out. Patient-level data were extracted from articles reporting validated depression measures (Beck Depression Inventory (BDI), Montgomery-Åsberg Depression Rating Scale (MADRS)), pre- and at least six months post surgery. To accommodate different outcome measures, the standardised mean difference (SMD) between both scores was used as the principal effect size. Data were synthesised using a random-effects model. (3) Results: Five distinct studies were identified, comprising 116 patients (64 included in meta-analysis). Effect size comparing post- vs. pre-operative scores was 1.66 (CI 1.25-2.07). Anterior cingulotomy (two studies, 22) and anterior capsulotomy (three studies, = 42) showed similar effect sizes: 1.51 (CI 0.82-2.20) vs. 1.74 (CI 1.23-2.26). Multiple procedures were performed in 30 of 116 (25.9%) patients. Based on patient-level data, 53% ( = 47) were responders (≥50% improvement), of which 34% reached remission (MADRS ≤ 10 or BDI ≤ 11). BDI mean improvement was 16.7 (44.0%) after a second procedure ( = 19). (4) Conclusions: The results are supportive of the benefit of SRA in selected patients with refractory MDD.
（1）背景：重度抑郁症（MDD）在全球疾病负担中占很大比例。立体定向射频消融术（SRA）对于某些患有最严重且难治性形式的患者可能有益，但效应大小尚不确定。（2）方法：对SRA治疗MDD进行了系统的文献综述和荟萃分析。从报告经过验证的抑郁量表（贝克抑郁量表（BDI）、蒙哥马利-阿斯伯格抑郁评定量表（MADRS））的文章中提取患者水平的数据，包括术前和术后至少六个月的数据。为了适应不同的结局测量指标，将两个分数之间的标准化平均差（SMD）用作主要效应大小。使用随机效应模型对数据进行综合分析。（3）结果：共识别出五项不同的研究，包括116名患者（荟萃分析纳入64名）。比较术后与术前分数的效应大小为1.66（95%置信区间1.25 - 2.07）。扣带回前部切开术（两项研究，n = 22）和内囊前肢切开术（三项研究，n = 42）显示出相似的效应大小：1.51（95%置信区间0.82 - 2.20）与1.74（95%置信区间1.23 - 2.26）。116名患者中有30名（25.9%）接受了多种手术。基于患者水平的数据，53%（n = 47）为反应者（改善≥50%），其中34%达到缓解（MADRS≤10或BDI≤11）。第二次手术后BDI平均改善为16.7（44.0%）（n = 19）。（4）结论：结果支持SRA对某些难治性MDD患者有益。
