Drane Daniel L, Pedersen Nigel P
Epilepsy Curr. 2019 May-Jun;19(3):174-176. doi: 10.1177/1535759719845326. Epub 2019 May 8.
Reversible Psychiatric Adverse Effects Related to Deep Brain Stimulation of the Anterior Thalamus in Patients With Refractory Epilepsy Järvenpää S, Peltola J, Rainesalo S, et al. Epilepsy Behav. 2018;88:373-379.
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-Åsberg Depression Rating Scale, Beck Depression Inventory, and Symptom Checklist prior to surgery, concentrating on former and current psychiatric symptoms and medications. The follow-up visit was 1 year after surgery.
At the group level, no changes in 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, 2 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.
难治性癫痫患者丘脑前核深部脑刺激相关的可逆性精神不良反应 耶尔文佩 S、佩尔托拉 J、莱内萨洛 S 等。《癫痫行为学》。2018 年；88:373 - 379。
丘脑前核（ANT）深部脑刺激（DBS）正成为治疗耐药性癫痫越来越常用的方法。癫痫与抑郁症存在双向关联。丘脑前核与前扣带回皮质和眶额内侧前额叶皮质有连接，因此，在情绪和执行功能方面可能发挥作用，所以，ANT DBS 可能会产生精神不良反应。我们的目的是评估接受 ANT DBS 手术的癫痫患者既往和当前的精神症状，并评估精神不良反应的可预测性。还报告了与程控相关的精神不良反应。
对 二十二名接受 ANT DBS 治疗难治性癫痫的患者进行检查，并在手术前使用蒙哥马利 - 阿斯伯格抑郁评定量表、贝克抑郁量表和症状清单对抑郁及其他精神症状进行精神评估，重点关注既往和当前的精神症状及用药情况。随访在术后 1 年进行。
在组水平上，ANT DBS 治疗期间未观察到情绪变化。两名有抑郁症病史的患者出现了与 DBS 程控设置相关的突发抑郁症状；在改变刺激参数后这些症状迅速缓解。此外，两名既往无精神病病史的患者逐渐出现明显的偏执和焦虑症状，在改变程控设置后也缓慢缓解。
我们的大多数 ANT DBS 患者未出现精神不良反应。某些 DBS 参数可能易引发突发抑郁或缓慢出现的偏执症状，这些症状可通过改变程控来逆转。
