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Abstract: Obsessive-compulsive disorder (OCD) is a common, chronic, disabling anxiety disorder characterized by recurrent obsessive thoughts and uncontrolled repetitive acts. Although many patients respond to various pharmacological treatments, there is a cohort of patients with intractable or refractory disease. The authors present the case of a patient with intractable OCD who was treated with bilateral electrical stimulators, which were stereotactically placed in the anterior limbs of the internal capsules. Following psychiatric consultation and 10 years of empirical medication regimens for OCD, a woman was referred for neurosurgical evaluation. After informed consent had been obtained from the patient, the authors placed bilateral stimulator leads in the anterior limbs of the internal capsules. The stereotactic coordinates were based on data in pertinent current literature. The stimulation parameters, which are presented in this paper, were set at 2 weeks and reviewed at 6 weeks and 3 months postoperatively. No changes were required. Postoperative analysis included evaluation by the patient's referring psychiatrist, a second independent psychiatrist, and pre- and postoperative administration of the Yale-Brown Obsessive Compulsive Scale. A marked improvement was noted in thispatient's OCD symptomatology and general psychosocial function. Previous documentation of patient responses to psychosurgical procedures for intractable or refractory OCD has been met with little enthusiasm, presumably because of the invasiveness and irreversibility of the surgery. In this report the authors suggest that deep brain stimulation of appropriate targets may be an effective and safe treatment for certain patients with OCD and a potentially reversible treatment for those patients who do not obtain therapeutic benefit. Abstract: Psychiatric neurosurgery teams in the United States and Europe have studied deep brain stimulation (DBS) of the ventral anterior limb of the internal capsule and adjacent ventral striatum (VC/VS) for severe and highly treatment-resistant obsessive-compulsive disorder. Four groups have collaborated most closely, in small-scale studies, over the past 8 years. First to begin was Leuven/Antwerp, followed by Butler Hospital/Brown Medical School, the Cleveland Clinic and most recently the University of Florida. These centers used comparable patient selection criteria and surgical targeting. Targeting, but not selection, evolved during this period. Here, we present combined long-term results of those studies, which reveal clinically significant symptom reductions and functional improvement in about two-thirds of patients. DBS was well tolerated overall and adverse effects were overwhelmingly transient. Results generally improved for patients implanted more recently, suggesting a 'learning curve' both within and across centers. This is well known from the development of DBS for movement disorders. The main factor accounting for these gains appears to be the refinement of the implantation site. Initially, an anterior-posterior location based on anterior capsulotomy lesions was used. In an attempt to improve results, more posterior sites were investigated resulting in the current target, at the junction of the anterior capsule, anterior commissure and posterior ventral striatum. Clinical results suggest that neural networks relevant to therapeutic improvement might be modulated more effectively at a more posterior target. Taken together, these data show that the procedure can be successfully implemented by dedicated interdisciplinary teams, and support its therapeutic promise. |
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quinidine: 金币+50, ★★★★★最佳答案, 谢谢！ 2014-09-09 01:30:46
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| 摘要：强迫症（OCD）是一种常见、慢性、致残性焦虑症，其特点是反复强迫思维和不受控制的重复行为。虽然很多患者对各种药物治疗有反应，但有患者群却呈顽固性或难治性特点。作者所呈现的一例经双侧电刺激治疗的顽固性强迫症患者，（刺激部位）通过立体定位将（电极）放置在内囊的前肢。经过精神科会诊和10年的经验性OCD药物方案治疗后，一名女性患者被转诊予以神经外科评估。从患者获得经过知情同意后，作者将刺激导线放置在双侧内囊前肢内。立体定向坐标的确定是基于目前的有关文献。（电）刺激参数会在本文内述及，在术后第2周设定，并于术后第6周和3个月后重新评估。评估结果无需作出任何调整。术后分析包括病人原来的精神科医生和第二方独立的精神科医生作出的评估，并结合耶鲁-布朗有关OCD的术前及术后的管理评估量表。在这个病人中，病人的OCD的症状和一般社会心理功能方面都有极大改善。以前的病史档案表明，病人对用于治疗顽固性或难治性OCD的精神外科手术的反应性很难达成，这可能是由于手术的侵袭性和不可能性造成。在这份报告中，作者认为对恰当靶位的深部脑刺激对某些OCD患者可能是一种有效而安全的治疗手段，对那些对其他治疗不能获益的病人可能是一种可逆性治疗措施。 |
2楼2014-09-09 00:31:46
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quinidine: 金币+50, 翻译EPI+1, ★★★★★最佳答案, 谢谢大侠！又忙到这么晚，感激啊~ 2014-09-09 01:30:37
quinidine: 金币+50, 翻译EPI+1, ★★★★★最佳答案, 谢谢大侠！又忙到这么晚，感激啊~ 2014-09-09 01:30:37
| 摘要：在美国及欧洲的精神神经外科团队已经研究了在腹侧内囊前肢及邻近腹侧纹状体（VC/VS）进行脑深部电刺激（DBS）对严重高难治性强迫症的影响。四个团队在过去8年经过最密切的合作，进行了小规模的研究。他们开始于Leuven/Antwerp团队，随后Butler医院/布朗医学院，克利夫兰诊所加入，最近佛罗里达州大学加入了这个合作团队。这些（医疗）中心使用相似的病人筛选标准和手术定位。其中手术定位（但是筛选标准）在此期间逐渐改善。在本文所我们所呈现的是这些研究的长期、综合结果，这些结果证实了（DBS）在三分之二病人中，出现症状减轻、功能改善等具有临床意义的结果。患者对DBS的整体耐受性很好，而且绝大多数副作用都是短暂的。结果显示新近植入（刺激导线）一般都有改善，提示各中心内部和各中心之间都有一个“学习曲线”。这也自从开展用DBS治疗运动障碍一来众所周知的现象。引起这种现象的主要因素是植入位点的重新适应和调整（细化）。在开始阶段，根据内囊前肢切开术之病灶位置，决定刺激部位在（内囊）的前、后肢。为改善治疗效果，选用更多后肢部位，也就是目前选用的靶位：内囊前肢、前连合和后腹侧纹状体的交界处。临床结果表明，与改善疗效相关的神经网络可能会在一更靠后的靶位得到更为有效的调节。总之，这些数据表明，可以通过专门的跨学科团队成功实施这一治疗措施（指DBS），并对其治疗承诺作出支持。 |
3楼2014-09-09 01:19:08
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