University of Tampere, Faculty of Medicine and Biosciences, Tampere, Finland; Tampere University Hospital, Department of Neurosciences, Neurology and Rehabilitation, Tampere, Finland.
Tampere University Hospital, Department of Neurosciences, Neurology and Rehabilitation, Tampere, Finland.
Epilepsy Behav. 2018 Nov;88:373-379. doi: 10.1016/j.yebeh.2018.09.006. Epub 2018 Oct 2.
Anterior nucleus of thalamus (ANT) deep brain stimulation (DBS) is becoming a more common treatment for drug-resistant epilepsy. Epilepsy and depression display a bidirectional association. Anterior nucleus of thalamus has connections to anterior cingulate cortex and orbitomedial prefrontal cortex, hence, a possible role in emotional and executive functions, and thus, ANT DBS might exert psychiatric adverse effects. Our aim was to evaluate previous and current psychiatric symptoms in patients with epilepsy undergoing ANT DBS surgery and assess the predictability of psychiatric adverse effects. Programming-related psychiatric adverse effects are also reported.
Twenty-two patients with ANT DBS for retractable epilepsy were examined, and a psychiatric evaluation of depressive and other psychiatric symptoms was performed with Montgomery and Åsberg Depression Rating Scale (MADRS), Beck Depression Inventory (BDI), and Symptom Checklist prior to surgery, concentrating on former and current psychiatric symptoms and medications. The follow-up visit was one year after surgery.
At the group level, no changes on mood were observed during ANT DBS treatment. Two patients with former histories of depression experienced sudden depressive symptoms related to DBS programming settings; these were quickly alleviated after changing the stimulation parameters. In addition, two patients with no previous histories of psychosis gradually developed clear paranoid and anxiety symptoms that also relieved slowly after changing the programming settings.
The majority of our ANT DBS patients did not experience psychiatric adverse effects. Certain DBS parameters might predispose to sudden depressive or slowly manifesting paranoid symptoms that are reversible via programming changes.
丘脑前核（ANT）深部脑刺激（DBS）正成为治疗耐药性癫痫的一种更为常见的方法。癫痫和抑郁症之间存在双向关联。ANT 与前扣带回皮质和眶额内侧前额叶皮质有联系，因此可能在情绪和执行功能中起作用，因此，ANT DBS 可能会产生精神不良影响。我们的目的是评估接受 ANT DBS 手术的癫痫患者的既往和当前精神症状，并评估精神病不良影响的可预测性。还报告了与编程相关的精神不良影响。
对 22 例因可退缩性癫痫接受 ANT DBS 的患者进行检查，并使用蒙哥马利和 Åsberg 抑郁评定量表（MADRS）、贝克抑郁量表（BDI）和症状清单对患者进行术前抑郁和其他精神症状的精神病评估，重点关注既往和当前的精神症状和用药情况。随访时间为术后一年。
在组水平上，ANT DBS 治疗期间未观察到情绪变化。两名有既往抑郁症病史的患者在 DBS 编程设置时出现突然的抑郁症状；这些症状在改变刺激参数后很快得到缓解。此外，两名无精神病既往史的患者逐渐出现明确的偏执和焦虑症状，这些症状在改变编程设置后也缓慢缓解。
我们的大多数 ANT DBS 患者未经历精神不良影响。某些 DBS 参数可能导致突然出现抑郁症状或逐渐出现偏执症状，这些症状可以通过编程更改来逆转。
