Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.
Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
Epilepsy Behav. 2023 Aug;145:109332. doi: 10.1016/j.yebeh.2023.109332. Epub 2023 Jul 8.
Stereotactic laser amygdalohippocampotomy (SLAH) is a minimally invasive surgical treatment for drug-resistant temporal lobe epilepsy (TLE) that has comparable rates of seizure freedom to traditional open resective TLE surgery. The objective of this study was to determine psychiatric outcome (i.e., depression and anxiety changes, psychosis) after SLAH, to explore possible contributory factors to these changes, and to determine the prevalence of de novo psychopathology.
We explored mood and anxiety in 37 adult patients with TLE undergoing SLAH using the Beck psychiatric symptoms scales (i.e., Beck Depression Inventory-II [BDI-II] and Beck Anxiety Inventory [BAI]) preoperatively and 6 months following surgery. Multivariable regression analysis was conducted to identify predictors of worse depression or anxiety symptoms following SLAH. The prevalence of de novo psychopathology following SLAH was also determined.
We found a significant decrease in BDI-II (mean decline from 16.3 to 10.9, p = 0.004) and BAI (mean decline from 13.3 to 9.0, p = 0.045) scores following SLAH at the group level. While the rate of resolution of depression (from 62% to 49%) did not achieve statistical significance (p = 0.13, McNemar's), the rate of resolution of anxiety (from 57% to 35%) was statistically significant (p = 0.03, McNemar's). The de novo rate of psychopathology (i.e., new onset depression or anxiety) following SLAH was 1 of 7 (14%). Using a metric of meaningful change rather than complete symptom resolution, 16 of 37 (43%) patients experienced improvement in depression and 6 of 37 (16%) experienced worsening. For anxiety, 14 of 37 (38%) experienced meaningful improvement and 8 of 37 (22%) experienced worsening. Baseline performance on the Beck Scales was the only factor contributing to outcome status.
In one of the first studies to evaluate psychiatric outcomes after SLAH, we found promising overall trends toward stability or significant improvement in symptom burden at the group level for both depression and anxiety. There was also a significant improvement in clinical anxiety, though the decrease in clinical depression was not significant, likely owing to the limitations of sample size. SLAH may improve overall psychiatric symptoms, similarly to traditional resective TLE surgery, but de novo psychopathology and postoperative psychiatric morbidity remain significant issues, and larger samples are necessary to determine causal contributory factors.
立体定向激光杏仁核海马切除术（SLAH）是一种治疗耐药性颞叶癫痫（TLE）的微创手术，其癫痫无发作率与传统的开放性 TLE 手术相当。本研究的目的是确定 SLAH 后的精神科结果（即抑郁和焦虑变化、精神病），探讨这些变化的可能促成因素，并确定新出现的精神病理学的患病率。
我们使用贝克精神病症状量表（即贝克抑郁量表第二版[BDI-II]和贝克焦虑量表[BAI]）在 37 名接受 SLAH 的成年 TLE 患者术前和术后 6 个月时评估他们的情绪和焦虑情况。采用多变量回归分析确定 SLAH 后抑郁或焦虑症状恶化的预测因素。还确定了 SLAH 后新出现精神病理学的患病率。
我们发现 SLAH 后 BDI-II（平均从 16.3 降至 10.9，p=0.004）和 BAI（平均从 13.3 降至 9.0，p=0.045）评分在组水平上显著下降。尽管抑郁缓解率（从 62%降至 49%）没有达到统计学意义（p=0.13，McNemar's），但焦虑缓解率（从 57%降至 35%）具有统计学意义（p=0.03，McNemar's）。SLAH 后精神病理学（即新发抑郁或焦虑）的新发病率为 1/7（14%）。使用有意义的变化而不是完全症状缓解的度量标准，37 名患者中有 16 名（43%）在抑郁方面有改善，37 名患者中有 6 名（16%）恶化。对于焦虑，37 名患者中有 14 名（38%）有明显改善，37 名患者中有 8 名（22%）恶化。贝克量表的基线表现是影响结果状态的唯一因素。
在第一项评估 SLAH 后精神科结果的研究之一中，我们发现无论是在抑郁还是焦虑方面，总体趋势都朝着群体水平的症状负担稳定或显著改善的方向发展。临床焦虑也有显著改善，尽管临床抑郁的下降没有统计学意义，可能是由于样本量的限制。SLAH 可能会改善整体精神症状，与传统的 TLE 切除术相似，但新出现的精神病理学和术后精神发病率仍然是一个重大问题，需要更大的样本量来确定因果促成因素。
