[Consensus Statement on deep brain stimulation for treatment-resistant obsessive-compulsive disorder].

Q4 Medicine Tijdschrift voor psychiatrie Pub Date : 2024-01-01
R J T Mocking, L Ackermans, I O Bergfeld, M Bot, J M C van Dijk, L Goossens, B C M Haarman, P P de Koning, A F G Leentjens, D E J Linden, P van den Munckhof, Y Namavar, D L M Oterdoom, K L Ho Pian, G van Rooijen, K R J Schruers, R Schuurman, Y Temel, N C C Vulink, D Denys
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引用次数: 0

Abstract

Background: Since 2013, deep brain stimulation (DBS) has been reimbursed in the Netherlands as a proven effective treatment for treatment-resistant obsessive-compulsive disorder (OCD). Nevertheless, DBS is still rarely applied, and a national Dutch treatment protocol is lacking.

Aim: To prepare a nationwide multidisciplinary treatment protocol for the application of DBS in the treatment of treatment-resistant OCD.

Method: Formulation of recommendations for the execution and application of DBS in OCD regarding indication, implantation, optimization of stimulation parameters, and consolidation of long-term effects, based on literature research and consensus among experts represented in the multidisciplinary Dutch DBS in Psychiatry working group.

Results: Following indication, DBS electrodes are bilaterally implanted in white matter tracts in the anterior limb of the internal capsule. In previously highly treatment-resistant patients with severe OCD, this leads to an average 66% response rate after optimization of stimulation parameters. Placebo-controlled effects are significant (Hedges’ g = 0.9). The main reported side effects are transient hypomanic symptoms, fatigue, and subjective cognitive complaints. Perioperative complications are rare. Positive effects remain stable during years of follow-up. DBS is cost-effective and leads to increased quality of life and functional recovery. Nevertheless, DBS is applied infrequently relative to the estimated number of patients with treatment-resistant OCD.

Conclusion: By adhering to the described recommendations regarding indication, implantation, optimization, and consolidation, DBS is an effective and safe treatment option for treatment-resistant OCD. A nationwide multidisciplinary treatment protocol can contribute to the implementation of DBS with more and earlier referrals, allowing more patients to benefit from this treatment more quickly.

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[关于深部脑刺激治疗难治性强迫症的共识声明]。
背景:自 2013 年起,脑深部刺激术(DBS)作为治疗耐药性强迫症(OCD)的一种行之有效的治疗方法,已在荷兰获得报销。尽管如此,深部脑刺激疗法仍很少应用,荷兰也缺乏全国性的治疗方案。目的:制定全国性的多学科治疗方案,应用深部脑刺激疗法治疗难治性强迫症:方法:在文献研究和荷兰多学科 DBS 精神病学工作组专家共识的基础上,就 DBS 在强迫症中的适应症、植入、刺激参数优化和长期效果巩固等方面的执行和应用提出建议:根据适应症,DBS 电极被双侧植入内囊前缘的白质束中。在优化刺激参数后,以前对治疗高度耐药的重度强迫症患者的平均应答率达到 66%。安慰剂对照效果显著(Hedges’ g = 0.9)。报告的主要副作用是短暂的躁狂症状、疲劳和主观认知抱怨。围手术期并发症很少见。积极效果在多年的随访中保持稳定。DBS 具有成本效益,可提高生活质量,促进功能恢复。尽管如此,相对于估计的难治性强迫症患者人数而言,DBS的应用并不频繁:结论:通过遵守所述关于适应症、植入、优化和巩固的建议,DBS 是治疗耐药强迫症的一种有效而安全的治疗方法。在全国范围内开展多学科治疗方案有助于更多和更早地转诊 DBS 患者,让更多患者更快地从这种治疗方法中获益。
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来源期刊
Tijdschrift voor psychiatrie
Tijdschrift voor psychiatrie Medicine-Medicine (all)
CiteScore
0.60
自引率
0.00%
发文量
118
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