Departments of Neurosurgery, Psychiatry and Behavioral Sciences, and Neuroscience, Baylor College of Medicine, Houston, Texas, USA; email:
Departments of Neurology, Neurosurgery, Psychiatry, and Neuroscience, Icahn School of Medicine at Mt. Sinai, New York, NY, USA.
Annu Rev Neurosci. 2023 Jul 10;46:341-358. doi: 10.1146/annurev-neuro-110122-110434. Epub 2023 Apr 5.
The field of stereotactic neurosurgery developed more than 70 years ago to address a therapy gap for patients with severe psychiatric disorders. In the decades since, it has matured tremendously, benefiting from advances in clinical and basic sciences. Deep brain stimulation (DBS) for severe, treatment-resistant psychiatric disorders is currently poised to transition from a stage of empiricism to one increasingly rooted in scientific discovery. Current drivers of this transition are advances in neuroimaging, but rapidly emerging ones are neurophysiological-as we understand more about the neural basis of these disorders, we will more successfully be able to use interventions such as invasive stimulation to restore dysfunctional circuits to health. Paralleling this transition is a steady increase in the consistency and quality of outcome data. Here, we focus on obsessive-compulsive disorder and depression, two topics that have received the most attention in terms of trial volume and scientific effort.
立体定向神经外科学发展于 70 多年前，旨在解决严重精神疾病患者的治疗空白。在此后的几十年里，它取得了巨大的发展，得益于临床和基础科学的进步。深部脑刺激（DBS）治疗严重、抗治疗的精神疾病目前正从经验阶段向越来越依赖科学发现的阶段过渡。推动这一转变的当前动力是神经影像学的进步，但迅速出现的是神经生理学的进步——随着我们对这些疾病的神经基础有了更多的了解，我们将能够更成功地使用侵入性刺激等干预措施来恢复功能失调的回路健康。与之平行的是，结果数据的一致性和质量稳步提高。在这里，我们专注于强迫症和抑郁症，这两个主题在试验数量和科学努力方面受到了最多的关注。
