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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: 金幣+50, ★★★★★最佳答案, 謝謝！ 2014-09-09 01:30:46
quinidine: 金幣+50, ★★★★★最佳答案, 謝謝！ 2014-09-09 01:30:46
| 摘要：強(qiáng)迫癥（OCD）是一種常見(jiàn)、慢性、致殘性焦慮癥，其特點(diǎn)是反復(fù)強(qiáng)迫思維和不受控制的重復(fù)行為。雖然很多患者對(duì)各種藥物治療有反應(yīng)，但有患者群卻呈頑固性或難治性特點(diǎn)。作者所呈現(xiàn)的一例經(jīng)雙側(cè)電刺激治療的頑固性強(qiáng)迫癥患者，（刺激部位）通過(guò)立體定位將（電極）放置在內(nèi)囊的前肢。經(jīng)過(guò)精神科會(huì)診和10年的經(jīng)驗(yàn)性O(shè)CD藥物方案治療后，一名女性患者被轉(zhuǎn)診予以神經(jīng)外科評(píng)估。從患者獲得經(jīng)過(guò)知情同意后，作者將刺激導(dǎo)線(xiàn)放置在雙側(cè)內(nèi)囊前肢內(nèi)。立體定向坐標(biāo)的確定是基于目前的有關(guān)文獻(xiàn)。（電）刺激參數(shù)會(huì)在本文內(nèi)述及，在術(shù)后第2周設(shè)定，并于術(shù)后第6周和3個(gè)月后重新評(píng)估。評(píng)估結(jié)果無(wú)需作出任何調(diào)整。術(shù)后分析包括病人原來(lái)的精神科醫(yī)生和第二方獨(dú)立的精神科醫(yī)生作出的評(píng)估，并結(jié)合耶魯-布朗有關(guān)OCD的術(shù)前及術(shù)后的管理評(píng)估量表。在這個(gè)病人中，病人的OCD的癥狀和一般社會(huì)心理功能方面都有極大改善。以前的病史檔案表明，病人對(duì)用于治療頑固性或難治性O(shè)CD的精神外科手術(shù)的反應(yīng)性很難達(dá)成，這可能是由于手術(shù)的侵襲性和不可能性造成。在這份報(bào)告中，作者認(rèn)為對(duì)恰當(dāng)靶位的深部腦刺激對(duì)某些OCD患者可能是一種有效而安全的治療手段，對(duì)那些對(duì)其他治療不能獲益的病人可能是一種可逆性治療措施。 |
2樓2014-09-09 00:31:46
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- 翻譯EPI: 1690
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quinidine: 金幣+50, 翻譯EPI+1, ★★★★★最佳答案, 謝謝大俠！又忙到這么晚，感激啊~ 2014-09-09 01:30:37
quinidine: 金幣+50, 翻譯EPI+1, ★★★★★最佳答案, 謝謝大俠！又忙到這么晚，感激啊~ 2014-09-09 01:30:37
| 摘要：在美國(guó)及歐洲的精神神經(jīng)外科團(tuán)隊(duì)已經(jīng)研究了在腹側(cè)內(nèi)囊前肢及鄰近腹側(cè)紋狀體（VC/VS）進(jìn)行腦深部電刺激（DBS）對(duì)嚴(yán)重高難治性強(qiáng)迫癥的影響。四個(gè)團(tuán)隊(duì)在過(guò)去8年經(jīng)過(guò)最密切的合作，進(jìn)行了小規(guī)模的研究。他們開(kāi)始于Leuven/Antwerp團(tuán)隊(duì)，隨后Butler醫(yī)院/布朗醫(yī)學(xué)院，克利夫蘭診所加入，最近佛羅里達(dá)州大學(xué)加入了這個(gè)合作團(tuán)隊(duì)。這些（醫(yī)療）中心使用相似的病人篩選標(biāo)準(zhǔn)和手術(shù)定位。其中手術(shù)定位（但是篩選標(biāo)準(zhǔn)）在此期間逐漸改善。在本文所我們所呈現(xiàn)的是這些研究的長(zhǎng)期、綜合結(jié)果，這些結(jié)果證實(shí)了（DBS）在三分之二病人中，出現(xiàn)癥狀減輕、功能改善等具有臨床意義的結(jié)果�；颊邔�(duì)DBS的整體耐受性很好，而且絕大多數(shù)副作用都是短暫的。結(jié)果顯示新近植入（刺激導(dǎo)線(xiàn)）一般都有改善，提示各中心內(nèi)部和各中心之間都有一個(gè)“學(xué)習(xí)曲線(xiàn)”。這也自從開(kāi)展用DBS治療運(yùn)動(dòng)障礙一來(lái)眾所周知的現(xiàn)象。引起這種現(xiàn)象的主要因素是植入位點(diǎn)的重新適應(yīng)和調(diào)整（細(xì)化）。在開(kāi)始階段，根據(jù)內(nèi)囊前肢切開(kāi)術(shù)之病灶位置，決定刺激部位在（內(nèi)囊）的前、后肢。為改善治療效果，選用更多后肢部位，也就是目前選用的靶位：內(nèi)囊前肢、前連合和后腹側(cè)紋狀體的交界處。臨床結(jié)果表明，與改善療效相關(guān)的神經(jīng)網(wǎng)絡(luò)可能會(huì)在一更靠后的靶位得到更為有效的調(diào)節(jié)�？傊�，這些數(shù)據(jù)表明，可以通過(guò)專(zhuān)門(mén)的跨學(xué)科團(tuán)隊(duì)成功實(shí)施這一治療措施（指DBS），并對(duì)其治療承諾作出支持。 |
3樓2014-09-09 01:19:08
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