Sobstyl Michał, Karamon Karol, Pietras Tadeusz, Sipowicz Kasper, Rylski Marcin
Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland.
Department of Neuroradiology, Institute of Psychiatry and Neurology, Warsaw, Poland.
Postep Psychiatr Neurol. 2025 Sep;34(3):177-188. doi: 10.5114/ppn.2025.153598. Epub 2025 Aug 26.
The bed nucleus of the stria terminalis (BNST) is a tiny nucleus connected by a bundle of axons with the amygdala. The BNST acts as a relay center, coordinating autonomic, limbic, behavioral, neuroendocrine, and motor functions. It plays a key role in anxiety and anxiety-related disorders. This review presents clinical outcomes of deep brain stimulation (DBS) of the BNST in treatment-resistant obsessive-compulsive disorder (trOCD) and treatment-resistant depression (TRD).
The medical literature search was conducted in MEDLINE and the Cochrane Central Register of Controlled Trials (CENTRAL). The identified studies were assessed on the basis of patient characteristics, clinical outcomes, and adverse events related to DBS. The reduction of the Y-OCBS in the reported studies ranged from 27% to 66%, with mean reduction of the YBOCS of 45% at a mean of 58 months. The authors of clinical studies also reported enhanced socio-occupational functioning and quality of life. Adverse effects included hypomania, depressive episodes, weight gain, emotional lability, and seizures. However, most side effects were transient and reversible with stimulation adjustments.
Clinical experience with BNST DBS remains limited, with most studies treating trOCD and only two addressing TRD. Reported outcomes suggest reductions in obsessions, compulsions, and affective symptoms, alongside improved daily functioning. The BNST appears to be a promising DBS target for anxiety-related psychiatric disorders.
终纹床核（BNST）是一个微小的核团，通过一束轴突与杏仁核相连。BNST作为一个中继中心，协调自主神经、边缘系统、行为、神经内分泌和运动功能。它在焦虑及焦虑相关障碍中起关键作用。本综述介绍了终纹床核深部脑刺激（DBS）治疗难治性强迫症（trOCD）和难治性抑郁症（TRD）的临床结果。
在MEDLINE和Cochrane对照试验中央注册库（CENTRAL）中进行了医学文献检索。根据患者特征、临床结果以及与DBS相关的不良事件对纳入的研究进行评估。在报告的研究中，耶鲁布朗强迫症量表（Y-OCBS）的降低幅度为27%至66%，平均随访58个月时，YBOCS平均降低45%。临床研究的作者还报告了社会职业功能和生活质量的改善。不良反应包括轻躁狂、抑郁发作、体重增加、情绪不稳定和癫痫发作。然而，大多数副作用是短暂的，通过调整刺激可以逆转。
BNST-DBS的临床经验仍然有限，大多数研究针对trOCD，只有两项研究针对TRD。报告的结果表明，强迫观念、强迫行为和情感症状有所减轻，日常功能也有所改善。BNST似乎是治疗焦虑相关精神障碍的一个有前景的DBS靶点。
