Anand Adrish, Gavvala Jay R, Mathura Raissa, Najera Ricardo A, Gadot Ron, Shofty Ben, Sheth Sameer A
Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, United States.
Department of Neurology, Baylor College of Medicine, Houston, Texas, United States.
Surg Neurol Int. 2022 Apr 29;13:178. doi: 10.25259/SNI_241_2022. eCollection 2022.
Anxiety is a common symptom of mental health disorders. Surgical treatment of anxiety-related disorders is limited by our understanding of the neural circuitry responsible for emotional regulation. Limbic regions communicate with other cortical and subcortical regions to generate emotional responses and behaviors toward anxiogenic stimuli. Epilepsy involving corticolimbic regions may disrupt normal neural circuitry and present with mood disorders. Anxiety presenting in patients with mesial temporal lobe epilepsy is common; however, anxiety in patients with cingulate epilepsy is not well described. Neurosurgical cases with rare clinical presentations may provide insight into the basic functionality of the human mind and ultimately lead to improvements in surgical treatments.
We present the case of a 24-year-old male with a 20-year history of nonlesional and cingulate epilepsy with an aura of anxiety and baseline anxiety. Noninvasive work-up was discordant. Intracranial evaluation using stereoelectroencephalography established the epileptogenic zone in the left anterior and mid-cingulate gyrus. Stimulation of the cingulate reproduced a sense of anxiety typical of the habitual auras. We performed laser interstitial thermal therapy of the left anterior and mid-cingulate gyrus. At 8 months following ablation, the patient reported a substantial reduction in seizure frequency and complete elimination of his baseline anxiety and anxious auras.
This case highlights the role of the cingulate cortex (CC) in regulating anxiety. Ablation of the epileptic focus resolved both epilepsy-related anxiety and baseline features.a Future studies assessing the role of the CC in anxiety disorders may enable improvements in surgical treatments for anxiety disorders.
焦虑是心理健康障碍的常见症状。焦虑相关障碍的外科治疗受到我们对负责情绪调节的神经回路理解的限制。边缘区域与其他皮质和皮质下区域进行交流，以产生对致焦虑刺激的情绪反应和行为。涉及皮质边缘区域的癫痫可能会破坏正常的神经回路，并表现出情绪障碍。内侧颞叶癫痫患者出现焦虑很常见；然而，扣带回癫痫患者的焦虑情况描述较少。具有罕见临床表现的神经外科病例可能有助于深入了解人类思维的基本功能，并最终改善外科治疗方法。
我们报告一例24岁男性，有20年非病变性扣带回癫痫病史，伴有焦虑先兆和基线焦虑。无创检查结果不一致。使用立体脑电图进行的颅内评估确定癫痫病灶位于左侧前扣带回和中扣带回。刺激扣带回重现了习惯性先兆典型的焦虑感。我们对左侧前扣带回和中扣带回进行了激光间质热疗。消融术后8个月，患者报告癫痫发作频率大幅降低，基线焦虑和焦虑先兆完全消除。
该病例突出了扣带回皮质（CC）在调节焦虑中的作用。癫痫病灶的消融解决了与癫痫相关的焦虑和基线症状。未来评估CC在焦虑症中作用的研究可能会改善焦虑症的外科治疗方法。
