Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
Neurosurgery. 2020 Sep 15;87(4):796-802. doi: 10.1093/neuros/nyaa051.
Post-traumatic stress disorder is a severe psychobiological disorder associated with hyperactivity of the amygdala, particularly on the right side. Highly selective laser ablation of the amygdalohippocampal complex is an effective neurosurgical treatment for medically refractory medial temporal lobe epilepsy that minimizes neurocognitive deficits relative to traditional open surgery.
To examine the impact of amygdalohippocampotomy upon symptoms and biomarkers of post-traumatic stress disorder.
Two patients with well-documented chronic post-traumatic stress disorder who subsequently developed late-onset epilepsy underwent unilateral laser amygdalohippocampotomy. Prospective clinical and neuropsychological measurements were collected in patient 1. Additional prospective measurements of symptoms and biomarkers were collected pre- and post-surgery in patient 2.
After laser ablation targeting the nondominant (right) amygdala, both patients experienced not only reduced seizures, but also profoundly abated post-traumatic stress symptoms. Prospective evaluation of biomarkers in patient 2 showed robust improvements in hyperarousal symptoms, fear potentiation of the startle reflex, brain functional magnetic resonance imaging responses to fear-inducing stimuli, and emotional declarative memory.
These observations support the emerging hypothesis that the right amygdala particularly perpetuates the signs and symptoms of post-traumatic stress disorder and suggests that focal unilateral amydalohippocampotomy can provide therapeutic benefit.
创伤后应激障碍是一种严重的心理生物学障碍，与杏仁核的过度活跃有关，尤其是右侧。选择性激光消融杏仁核海马复合体是一种有效的神经外科治疗方法，用于治疗药物难治性内侧颞叶癫痫，与传统的开放性手术相比，可最大程度地减少神经认知缺陷。
研究杏仁核海马切除术对创伤后应激障碍症状和生物标志物的影响。
两名有明确记录的慢性创伤后应激障碍患者随后出现迟发性癫痫，接受了单侧激光杏仁核海马切除术。对患者 1 进行了前瞻性临床和神经心理学测量。对患者 2 进行了手术前后症状和生物标志物的额外前瞻性测量。
在针对非优势（右侧）杏仁核的激光消融后，两名患者不仅癫痫发作减少，而且创伤后应激症状明显减轻。对患者 2 的生物标志物进行前瞻性评估显示，过度警觉症状、惊吓反射的恐惧增强、对恐惧诱发刺激的脑功能磁共振成像反应以及情绪陈述性记忆均有显著改善。
这些观察结果支持了一个新兴假说，即右侧杏仁核特别地持续存在创伤后应激障碍的症状和体征，并表明单侧杏仁核海马切除术可以提供治疗益处。
