| アブストラクト | BACKGROUND: Ventral capsule/ventral striatum deep brain stimulation (VC/VS-DBS) for treatment-resistant depression (TRD) has shown promising results. Despite its efficacy, DBS is costly and less accessible, while anterior capsulotomy (ACAPS), though permanent and non-adjustable, offers clinical advantages. METHODS: A systematic review and data analysis were conducted to evaluate articles reporting on clinical outcomes and adverse effects of VC/VS-DBS and ACAPS for TRD. A quality assessment of the included studies was performed to determine homogeneity across reports. To assess the intervention's efficacy, changes in pre- and post-intervention scores on the Hamilton Depression Rating Scale (HRSD-17) were analyzed. RESULTS: Seven studies with 138 TRD patients were analyzed. Among 75 ACAPS patients, mean pre-operative HRSD-17 scores decreased by 46 %, from 26.97 +/- 3.12-14.53 +/- 1.15, with an improvement of 11.87 points (95 % CI: 8.83-14.91). For 63 VC/VS-DBS patients, scores declined by 42 %, from 27.5 +/- 4.13-15.93 +/- 5.13, corresponding to an improvement of 9.68 points (95 % CI: 5.08-14.27). Adverse effects included suicidal ideation (7 %) and hypomania (3.6 %) with DBS, while ACAPS was associated with headaches and long-term effects like reduced motivation and weight gain in 15-20 % of patients. CONCLUSION: Both VC/VS-DBS and ACAPS show efficacy in treating TRD, with ACAPS showing slightly better outcomes and no significant adverse effects reported. However, given study heterogeneity, a robust, well-powered randomized controlled trial is essential to more precisely compare these techniques and clarify their clinical impact on TRD. |
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| ジャーナル名 | Clinical neurology and neurosurgery |
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| Pubmed追加日 | 2025/2/25 |
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| 投稿者 | Armas-Salazar, Armando; Fernandez-Gutierrez, Luis M; Jader, Arwa; Avecillas-Chasin, Josue M; Aronson, Joshua P; Pacheco-Barrios, Niels; Altamirano, Juan M |
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| 組織名 | Facultad Mexicana de Medicina, Universidad la Salle, Mexico City, Mexico.;Universidad Anahuac, Queretaro, Mexico.;Kufa University, Faculty of Medicine, Kufa, Iraq.;Department of Neurosurgery University of Nebraska Medical Center, Omaha, NE, USA.;Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, MA, USA.;Harvard Medical School, Boston, MA, USA.;Hospital Angeles Clinica Londres, Department of Neurosurgery, Mexico;City, Mexico. Electronic address: jmaltamirano83@gmail.com. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/39994933/ |
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