deep brain stimulation（DBS）深部脑刺激
“The emergence of deep brain stimulation (DBS) as an intervention for treatment-resistant psychiatric disorders is the result of an evolution of understanding of brain function and disease mechanisms across a variety of disciplines within neuroscience and medicine. Refinement of brain imaging strategies has increasingly linked specific symptoms or behaviours with discrete brain regions. Highly sophisticated neuroscience techniques, such as optogenetics, have allowed for an increased understanding of neurocircuitry in awake and behaving animals and the development of more sophisticated translational animal models linking brain and behaviour to human disease. Refinement of neurosurgical techniques led to its expansion into neuropsychiatric disorders, most notably movement disorders. The success of lesioning techniques in Parkinson’s disease gave rise to the use of high-frequency DBS at the same target sites, with the initial conception of DBS as a reversible lesion .” (“New oxford textbook of psychiatry”, 2020, p. 183) 脑深部电刺激( deep brain stimulation，DBS )作为治疗难治性精神障碍的干预措施的出现，是神经科学和医学各学科对大脑功能和疾病机制认识演进的结果。脑成像策略的精细化已经越来越多地将特定的症状或行为与离散的脑区联系起来。高精尖的神经科学技术，如光遗传学，使人们对清醒和行为动物中的神经环路有了更多的了解，并发展了更先进的转化动物模型，将大脑和行为与人类疾病联系起来。神经外科技术的改进使其扩展到神经精神疾病，尤其是运动障碍。帕金森病损毁技术的成功使得在相同的靶点使用高频DBS，最初认为DBS是一种可逆性病变。
“As these various disciplines evolved in parallel, there is no single rationale for using DBS to treat psychiatric disorders.For example, use of DBS in the region of the internal capsule for obsessive–compulsive disorder (OCD) and depression largely grew out of the history of performing anterior capsulotomy and other surgical lesions for severe, treatment-resistant cases.” (“New oxford textbook of psychiatry”, 2020, p. 183) 由于这些不同的学科是平行发展的，因此使用DBS治疗精神疾病没有单一的理论基础。例如，在内囊区域使用DBS治疗强迫症( OCD )和抑郁症，很大程度上源于对严重的、难以治疗的病例进行前囊膜切开术和其他外科手术的历史。
“Targeting the subcallosal cingulate cortex (SCC) with DBS was the direct extension of neuroimaging findings demonstrating SCC hyperactivity in depression and subsequent normalization of activity following successful treatment, irrespective of treatment modality. Consideration of the nucleus accumbens (NAC) and medial forebrain bundle (MFB) as DBS targets relied heavily on the work in animal models to understand limbic circuitry and reward, implicating the NAC and associated monoaminergic inputs in drive, motivation, and positive reinforcement, all of which are important aspects of nearly any psychiatric syndrome.” (“New oxford textbook of psychiatry”, 2020, p. 183) 使用DBS靶向胼胝体下扣带回皮层( subcallosal cingulate cortex，SCC )是神经影像学发现的直接延伸，表明抑郁症中SCC的过度活动以及成功治疗后的活动正常化，不管治疗方式如何。伏隔核( NAC )和内侧前脑束( MFB )作为DBS靶点的考虑在很大程度上依赖于动物模型中的工作来理解边缘系统回路和奖赏，这意味着NAC和相关的单胺能输入在驱动、动机和正性强化中，所有这些都是几乎任何精神综合征的重要方面。
“Regardless of the target or rationale, all of the data reviewed here represent experimental attempts to treat a subset of patients for whom standard treatments have failed (OCD, depression, eating disorders, addiction) or who suffer from an illness for which there is no treatment that significantly modifies the disease trajectory [Alzheimer’s disease (AD)]. Treatment resistance is defined differently for each disorder, although typically it includes non-response or loss of response to multiple medication categories and a validated psychotherapy trial.” (“New oxford textbook of psychiatry”, 2020, p. 183) 不管是哪种目标或理论基础，这里回顾的所有数据都代表了对标准治疗失败的(强迫症、抑郁症、进食障碍、成瘾)或患有疾病的患者进行治疗的实验尝试，因为没有治疗显著改变疾病轨迹[阿尔茨海默病( Alzheimer ‘ s disease , AD )]。治疗抵抗对每种疾病的定义是不同的，尽管它通常包括对多种药物类别的无反应或失去反应以及经过验证的心理治疗试验。
“. DBS for OCD does have the CE Mark approval for use in Europe. In the United States, DBS is not US Food and Drug Administration (FDA)-approved for any psychiatric disorder, although the FDA did grant a humanitarian device exemption (HDE) for use in OCD. (For comparison, DBS is FDA-approved for Parkinson’s disease and essential tremor, and there is an HDE for dystonia.) The current state of DBS for psychiatric disorders is therefore still very early and largely experimental, driven by the absence of any effective treatment in this subset of patients with severe and treatment-refractory illness. With continued research on brain circuit abnormalities in other conditions, the breadth of potential applications of targeted neuromodulation is likely to increase.” (“New oxford textbook of psychiatry”, 2020, p. 183) 。DBS for OCD的确有CE Mark认证在欧洲使用。在美国，DBS不是美国食品药品监督管理局( Food and Drug Administration，FDA )批准的用于任何精神疾病的药物，尽管FDA批准了用于OCD的人道主义设备豁免( HDE )。因此，DBS治疗精神疾病的现状仍然很早，而且在很大程度上是实验性的，因为在这一严重和治疗难治性疾病的患者中没有任何有效的治疗。随着对其他条件下脑电路异常的持续研究，靶向神经调控的潜在应用的广度很可能会增加。