Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
CNS Neurosci Ther. 2019 Aug;25(8):824-831. doi: 10.1111/cns.13118. Epub 2019 Mar 13.
Patients with epilepsy and refractory comorbid psychiatric disorders often experience functional impairments and a lower quality of life as well as showing a lack of compliance with anti-epileptic medication regimens. We reasoned that widespread clinical benefits could be gained if the psychiatric comorbidities among these patients were reduced. In this study, we assessed the utility of anterior capsulotomy in managing medication-refractory comorbid psychotic symptoms and aggression in patients with epilepsy.
In this retrospective case series, we evaluated the clinical outcomes of 13 epilepsy patients with severe psychiatric comorbidities who had received bilateral anterior capsulotomy. Clinical outcome assessments were performed at 1 week, 6 months, 1 year, and several years after surgery focusing on: (a) severity of psychotic symptoms, as assessed by the 18-item Brief Psychiatric Rating Scale and the Positive and Negative Syndrome Scale; (b) severity of impulsivity and aggression, measured by the Barratt Impulsiveness Scale-11 and the Buss-Perry Aggression Scale; and (c) social function and quality of life, assessed by the Social Disability Screening Scale and the Quality of Life in Epilepsy.
After anterior capsulotomy, patients displayed significant improvements of psychotic symptoms, as well as of impulsivity and aggression, along with improvements of social function and quality of life. The clinical benefits to patients were evident within 6 months after surgery and remained stable or continued to improve at a much slower rate thereafter. Furthermore, after anterior capsulotomy all patients complied with epilepsy interventions that they did not comply with prior to surgery. No significant side effects or complications occurred during the study.
Anterior capsulotomy seems to be a safe and effective treatment for epilepsy patients with otherwise intractable comorbid psychotic symptoms and aggression. Moreover, this neurosurgical treatment may improve the patients' social function, quality of life, and compliance with anti-epilepsy medication regimens.
患有癫痫和难治性合并精神疾病的患者经常会出现功能障碍和生活质量下降，并且对抗癫痫药物治疗方案的依从性较差。我们认为，如果这些患者的合并精神疾病得到减少，将会获得广泛的临床益处。在这项研究中，我们评估了前囊切开术在治疗癫痫患者药物难治性合并精神病症状和攻击性方面的效用。
在这项回顾性病例系列研究中，我们评估了 13 名患有严重合并精神疾病的癫痫患者接受双侧前囊切开术的临床结果。在手术后 1 周、6 个月、1 年和数年进行临床结果评估，重点评估以下内容：（a）18 项简明精神病评定量表和阳性和阴性综合征量表评估的精神病症状严重程度；（b）Barratt 冲动量表-11 和 Buss-Perry 攻击量表评估的冲动和攻击严重程度；（c）社会功能和生活质量，由社会残疾筛查量表和癫痫生活质量评估。
在前囊切开术后，患者的精神病症状、冲动和攻击以及社会功能和生活质量均有显著改善。手术后 6 个月内患者即出现临床获益，此后保持稳定或以较慢的速度继续改善。此外，在前囊切开术后，所有患者都遵守了他们在手术前不遵守的癫痫干预措施。在研究期间没有发生明显的副作用或并发症。
前囊切开术似乎是治疗癫痫患者合并难治性精神病症状和攻击性的一种安全有效的方法。此外，这种神经外科治疗可能会改善患者的社会功能、生活质量和对抗癫痫药物治疗方案的依从性。
