脑深部电刺激治疗难治性抑郁障碍临床疗效及机制研究进展

Clinical effectiveness and its mechanisms of deep brain stimulation in treatment-resistant depressive disorders

脑深部电刺激是难治性抑郁障碍的新兴治疗手段之一。本文概述了脑深部电刺激治疗难治性抑郁障碍的诸多潜在靶点,归纳了相关临床研究的结果。这些靶点包括胼胝体下扣带回,伏隔核,腹侧内囊和腹侧纹状体区域,内侧前脑束等区域。在这些研究的基础上,本文结合相关基础研究,在突触可塑性、神经电生理、神经环路及神经递质等层面进一步讨论了脑深部电刺激发挥治疗效果可能的机制,并对其进一步推广的应用潜力做出评估和展望。结合现有临床研究结果和神经生物学机制的多靶点联合刺激可能是提高脑深部电刺激治疗难治性抑郁障碍的重要发展方向。

Deep brain electrical stimulation is one of the emerging therapeutic approaches for treatment-resistant depressive disorders.This article outlines a variety of potential targets for deep brain electrical stimulation in the treatment of treatment-resistant depressive disorders and summarizes the results of relevant clinical studies.These targets include the subgenual cingulate gyrus,nucleus accumbens,ventral capsule and ventral striatum area,medial forebrain bundle,and lateral habenula,among other regions.Based on these studies,the article integrates relevant basic research and further discusses the possible mechanisms through which deep brain stimulation may exert therapeutic effects,including synaptic plasticity,neurophysiology,neural circuits,and neurotransmitters.The article also assesses and prospects the further application potential of deep brain electrical stimulation.The authors believe that the multi-target stimulation combining existing clinical research results and neurobiological mechanisms could be a crucial development direction to enhance the treatment of treatment-resistant depressive disorders using deep brain electrical stimulation.