脑深部电刺激在难治性强迫症治疗中的研究进展

Current progress of deep brain stimulation for obsessive-compulsive disorder

强迫症是一组以强迫思维和(或)强迫行为为主要表现的精神疾病,目前临床上的一线治疗方案为5-羟色胺再摄取抑制剂和认知行为治疗。但仍有约40%~60%患者对一线治疗反应不佳或无效,称之为难治性强迫症。2009年美国及欧洲药监局批准的脑深部电刺激(deep brain stimulation,DBS)技术,作为一种神经调控的新型疗法能安全有效地改善难治性强迫症患者的症状。我们总结了现阶段对强迫症发病机制的了解,阐述了DBS应用于强迫症的历史和最新进展,并对其治疗机制、疗效、安全性、局限性及今后的发展方向等进行了综述。

Obsessive-compulsive disorder(OCD)is a mental disorder mainly characterized by obsessive thoughts and obsessive behaviors.Selective serotonin reuptake inhibitors(SSRIs)and cognitive behavioral therapy(CBT)are currently the first-line treatment for OCD.However,about 40%-60%of OCD patients are refractory to standard pharmacotherapy and psychotherapy and further diagnosed with refractory OCD.Deep brain stimulation(DBS),a new therapy of neural modulation,can safely and effectively ameliorate the symptoms of refractory OCD patients.It was approved by Food and Drug Administration(FDA)and European Medicines Agency(EMA)in 2009 for treating OCD.In this paper,the latest progress on the pathophysiology of OCD is summarized.Besides,the history and latest reseach progression of the application of DBS in OCD are instroduced.Furthermore,the mechanisms,clinical efficacy,safety and limitations of DBS are reviewed.