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Kích thích não sâu cho trầm cảm kháng trị: Tổng quan hệ thống về kết quả lâm sàng
Tóm tắt
Rối loạn trầm cảm chính (MDD) là một rối loạn phổ biến, nghiêm trọng và gây tàn phế, làm giảm đáng kể chất lượng cuộc sống. Thuốc thường có hiệu quả tốt, nhưng 20-30% bệnh nhân không đáp ứng với liệu pháp y tế. Điều trị phẫu thuật cho các rối loạn tâm thần có một sự kỳ thị tiêu cực do những lạm dụng trong lịch sử. Nhiều phẫu thuật gạch bỏ cho MDD đã được thực hiện với thành công hạn chế, nhưng những nghiên cứu này thiếu các tiêu chí kết quả tiêu chuẩn hóa. Sự phát triển gần đây của liệu pháp điều chỉnh thần kinh, đặc biệt là kích thích não sâu (DBS), đã cho phép các nghiên cứu có kiểm soát với kích thích giả và tạo ra một lựa chọn điều trị tiềm năng vừa đảo ngược vừa điều chỉnh được. Chúng tôi đã thực hiện một tổng quan có hệ thống về tài liệu liên quan đến DBS cho trầm cảm kháng trị nhằm đánh giá tính an toàn và hiệu quả của quy trình này. Chúng tôi chỉ bao gồm các nghiên cứu sử dụng các tiêu chí kết quả được xác thực. Tổng quan của chúng tôi đã xác định 22 bài báo nghiên cứu lâm sàng với 5 phương pháp DBS độc nhất sử dụng các mục tiêu khác nhau, bao gồm hạch nhân accumbens, striatum ventral/capsule ventral, vỏ não cingulate dưới, hạch havebula ngoại vi, hạch thalamic phía dưới và bó não giữa. Trong số 22 nghiên cứu đã công bố, chỉ có 3 là thử nghiệm có kiểm soát, và 2 thử nghiệm được thực hiện nhiều trung tâm, ngẫu nhiên, có kiểm soát đánh giá hiệu quả của DBS vùng vỏ não cingulate dưới và striatum ventral/capsule ventral vừa bị ngưng lại gần đây do không hiệu quả dựa trên các phân tích vô dụng. Tổng thể, tỷ lệ phản ứng công bố với liệu pháp DBS, được định nghĩa là tỷ lệ phần trăm bệnh nhân có sự cải thiện > 50 % trên Thang đánh giá Trầm cảm Hamilton, được báo cáo là khoảng 40-70 %, và kết quả tương đối đồng nhất giữa các nghiên cứu. Chúng tôi kết luận rằng DBS cho MDD cho thấy tiềm năng, nhưng vẫn còn thuộc loại thử nghiệm và cần tích lũy thêm dữ liệu.
Từ khóa
#Rối loạn trầm cảm chính #kích thích não sâu #trầm cảm kháng trị #liệu pháp điều chỉnh thần kinh #kết quả lâm sàngTài liệu tham khảo
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