强迫症脑深部刺激的现状、挑战和未来方向。

IF 2.9 3区 医学 Q3 ENGINEERING, BIOMEDICAL Expert Review of Medical Devices Pub Date : 2023-07-01 Epub Date: 2023-09-07 DOI:10.1080/17434440.2023.2252732
Lauren Fanty, Jun Yu, Nita Chen, Drew Fletcher, Grace Hey, Michael Okun, Josh Wong
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引用次数: 0

摘要

引言:强迫症(OCD)在临床和病理上都是异质性的,其症状往往难以一线治疗。脑深部刺激(DBS)治疗难治性强迫症提供了一个调整和个体化神经调控靶向强迫症下异常电路的机会。DBS治疗的定制可以允许基于患者特定病理学的症状控制的精确性。在了解DBS干预的潜在目标方面取得了进展;然而,关于最佳目标的共识尚未达成。涵盖领域:通过查询PubMed数据库对DBS治疗强迫症进行文献综述。涵盖了以下主题:强迫症中DBS靶向的演变,底层统一连接组网络的概念,当前DBS靶向,该领域面临的挑战,以及在这一具有挑战性的人群中推进个性化DBS的未来方向。专家意见:为了继续提高DBS治疗强迫症的疗效,我们必须进一步探索强迫症临床特征和神经精神领域的最佳DBS反应,以及针对异常回路、多个异常回路或连接中枢中多个点的干预措施如何影响临床反应。此外,生物标志物在编程调整和创建闭环范式以解决日常生活中的症状波动方面将是非常宝贵的。
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The current state, challenges, and future directions of deep brain stimulation for obsessive compulsive disorder.

Introduction: Obsessive-compulsive disorder (OCD) is clinically and pathologically heterogenous, with symptoms often refractory to first-line treatments. Deep brain stimulation (DBS) for the treatment of refractory OCD provides an opportunity to adjust and individualize neuromodulation targeting aberrant circuitry underlying OCD. The tailoring of DBS therapy may allow precision in symptom control based on patient-specific pathology. Progress has been made in understanding the potential targets for DBS intervention; however, a consensus on an optimal target has not been agreed upon.

Areas covered: A literature review of DBS for OCD was performed by querying the PubMed database. The following topics were covered: the evolution of DBS targeting in OCD, the concept of an underlying unified connectomic network, current DBS targets, challenges facing the field, and future directions which could advance personalized DBS in this challenging population.

Expert opinion: To continue the increasing efficacy of DBS for OCD, we must further explore the optimal DBS response across clinical profiles and neuropsychiatric domains of OCD as well as how interventions targeting multiple points in an aberrant circuit, multiple aberrant circuits, or a connectivity hub impact clinical response. Additionally, biomarkers would be invaluable in programming adjustments and creating a closed-loop paradigm to address symptom fluctuation in daily life.

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来源期刊
Expert Review of Medical Devices
Expert Review of Medical Devices 医学-工程:生物医学
CiteScore
5.90
自引率
3.20%
发文量
69
审稿时长
6-12 weeks
期刊介绍: The journal serves the device research community by providing a comprehensive body of high-quality information from leading experts, all subject to rigorous peer review. The Expert Review format is specially structured to optimize the value of the information to reader. Comprehensive coverage by each author in a key area of research or clinical practice is augmented by the following sections: Expert commentary - a personal view on the most effective or promising strategies Five-year view - a clear perspective of future prospects within a realistic timescale Key issues - an executive summary cutting to the author''s most critical points In addition to the Review program, each issue also features Medical Device Profiles - objective assessments of specific devices in development or clinical use to help inform clinical practice. There are also Perspectives - overviews highlighting areas of current debate and controversy, together with reports from the conference scene and invited Editorials.
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