脑深部电刺激治疗难治性抑郁症的靶点研究进展

Targets of deep brain stimulation in the treatment-resistant depression:ongoing research and perspective

近年来诸多研究表明深部脑电刺激(deep brain stimulation,DBS)对难治性抑郁症具有一定疗效,但个体最佳刺激靶点选择尚缺乏一致标准。临床研究已证实和尝试的DBS靶点中,胼胝体扣带回、腹侧内囊/腹侧纹状体、伏隔核研究相对成熟,其抗抑郁效果较明确且相对安全,内侧前脑束靶点具有一定潜力,丘脑下脚、外侧缰核和终纹床核等靶点多为小样本病例报告,缺乏重复性研究支持。因难治性抑郁症异质性大,且DBS为有创治疗,目前研究存在一定挑战。而结合临床特点和生物学标识的个体化、精准化刺激靶点是未来值得研究的方向。

Several researches have recently proposed that deep brain stimulation(DBS)has certain curative effect on treatment-resistant depression(TRD).However,there is still a lack of consistent criteria for the selection of the best stimulation target.Among confirmed and attempted DBS targets,Brodmann area 25/subcallosal cingulate,ventral internal capsule/ventral striatum and nucleus accumbens are relatively mature and their antidepressant effect is relatively clear and safe.The targets of the medial forebrain tract have certain potentials.The targets of the subthalamic foot,nucleus accumbens,lateral habenular nucleus,medial forebrain tract and bed nucleus of stria terminalis are mostly small sample case reports,lacking repetitive research support.Due to the large heterogeneity of TRD and the invasive treatment of DBS,there are some challenges in the current research.The individualized and precise stimulation targets combined with clinical characteristics and biological markers are worth studying in the future.