CAJ | 학술논문

目的探讨脑深部电刺激(DBS)治疗难治性神经性厌食症.方法 4例经过心理及药物治疗无效的难治性神经性厌食症患者,接受磁共振导向立体定向双侧伏隔核DBS植入,术后给予持续慢性高频电刺激.采用身体质量指数(BMI)及其他精神科量表如Yale - Brown强迫症量表(YBOCS)、汉密尔顿焦虑量表(HAMA)评估DBS治疗难治性神经性厌食症的长期疗效.结果所有患者随访9-50个月(平均39个月).经过3-12个月的慢性电刺激,患者BMI由术前的平均11.4增加到17.9,同时进食行为及强迫、焦虑症状也明显缓解.4例患者的月经均完全恢复正常.其中2例在术后30个月后刺激器因电池耗尽而取出,患者治疗效果稳定,所有患者未出现不良反应及手术并发症.结论伏隔核DBS是治疗难治性神经性厌食症有效及安全的方法,不仅可改善进食障碍,同时对伴随的强迫焦虑症状也有明显改善.
목적 탐토뇌심부전자격(DBS)치료난치성신경성염식증.방법 4례경과심리급약물치료무효적난치성신경성염식증환자,접수자공진도향입체정향쌍측복격핵DBS식입,술후급여지속만성고빈전자격.채용신체질량지수(BMI)급기타정신과량표여Yale - Brown강박증량표(YBOCS)、한밀이돈초필량표(HAMA)평고DBS치료난치성신경성염식증적장기료효.결과 소유환자수방9-50개월(평균39개월).경과3-12개월적만성전자격,환자BMI유술전적평균11.4증가도17.9,동시진식행위급강박、초필증상야명현완해.4례환자적월경균완전회복정상.기중2례재술후30개월후자격기인전지모진이취출,환자치료효과은정,소유환자미출현불량반응급수술병발증.결론 복격핵DBS시치료난치성신경성염식증유효급안전적방법,불부가개선진식장애,동시대반수적강박초필증상야유명현개선.
Objective To study the effect of deep brain stimulation (DBS) in bilateral nucleus accumbens (NAc) for patients with refractory anorexia nervosa.Methods Four patients with severe,refractory anorexia nervosa who failed to psychological,medical and behavior therapies underwent DBS of bilateral NAc.DBS electrodes were implanted by MRI guided stereotactic surgery.The body mass index (BMI) and other psychiatrist - rated scales such as Yale - Brown obsessive - compulsive rating scale (YBOCS) and Hamilton anxiety rating scale ( HAMA ) were performed as a double - blind clinical assessment before and after surgery by psychiatrists.Results All patients were followed - up from 9 to 50 months (mean 39 months).Compared with preoperative baseline condition (mean BMI =11.4),the score was gradually increased to normal ( BMI ＞ 17.9) after stimulation for 3 - 12 months.Meanwhile,their eating behavior,OCD,anxiety symptoms were also improved slowly but steadily.The menstrual of all these patients recovered after stimulation of 3 - 12 months.The DBS devices of 2 patients were removed 30 months after the surgery because the battery were worn out and the effects were stable during the follow - up period.There was no severe side effect and complication in these patients.Conclusions NAc stimulation is very effective and safe for the treatment of refractory anorexia nervosa.It is a promising procedure to improve anorexia symptoms as well as its accompanied psychiatric symptoms.