对抗治疗重度抑郁症的深度大脑刺激:对刺激目标的网络元分析
Anant Naik1, Tiffany Chu2, Rishabh Gupta3
11Department of Neurosurgery, University of Minnesota Twin Cities, Minneapolis, Minnesota.
Journal of neurosurgery
|September 5, 2025
概括
深度大脑刺激 (DBS) 在治疗耐药性抑郁症方面是有前途的. 针对中部前脑 (MFB) 导致患者症状减少最多,反应率最高.
科学领域:
- 神经科学
- 精神病学
- 医疗技术
背景情况:
- 大型抑郁症 (MDD) 影响全球1.93亿人,其中40%对标准治疗没有反应.
- 深度大脑刺激 (DBS) 是一种治疗耐药性抑郁症 (TRD) 的神经调节疗法.
- 对TRD的最佳DBS脑位仍未确定.
研究的目的:
- 系统地审查和对TRD的DBS目标疗效进行元分析.
- 为了比较不同DBS目标在减轻抑郁症状方面的有效性.
- 确定未来研究和临床应用的最佳目标.
主要方法:
- 系统文献审查和22项试验 (15项假控制) 的网络元分析,截至2022年1月.
- 主要结果:抑郁症严重程度的降低 (MADRS,HAM-D).
- 二次结果:反应率和缓解率.
主要成果:
- 与SCG和VC/ VS相比,中脑前脑束 (MFB) 刺激显示出抑郁症状的最大减少.
- 与SCG或ALIC相比,MFB刺激的响应率更高 (86%).
- 罗斯特拉前额皮层刺激趋向于更高的缓解率 (60%),但不是显著的.
结论:
- 由于MFB在中皮层和中皮层路径中的作用,MFB是TRD的一个有希望的DBS目标.
- 需要进一步的直接比较试验来确认MFB是最佳的神经刺激目标.
- 对于药物治疗反应有限的患者,DBS提供了潜在的替代方案.
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