Hamdi Hussein, Aref Hend Mohamed
Neurosurgery Department, Tanta University, Tanta, Egypt.
Psychiatry and Neurology Centre, Tanta University, Tanta, Egypt.
Case Rep Neurol. 2024 Apr 10;16(1):99-106. doi: 10.1159/000538331. eCollection 2024 Jan-Dec.
The use of surgery for treatment of psychiatric conditions is a well-established strategy, especially in severe and resistant obsessive-compulsive disorder. Attractive anatomical and functional targets for stereotactic surgery are reported in some studies. Surgery for treatment of psychiatric conditions in our nation and Arab world is obscured and hidden because of several social and cultural limitations, which should be overcome. We report here the first psychiatric neurosurgery in our nation and how we overcome such community limitation. This the first report of postoperative tremor.
Young patient presented with severe and persistent obsessive-compulsive disorder resistant to all non-surgical modalities for several years. Stereotactic ablation surgery was done under local anaesthesia. Marked improvement in our obsessive-compulsive disorder patient after psychiatric neurosurgery with self-limited tremor was not reported before in the literature. The medications were the same before and immediate after surgery and this is not a drug-induced tremor. Postoperative YBOCS showed 90% of improvement.
Surgery-induced tremor could be a self-limited side effect after surgery in obsessive-compulsive disorder. Safety and efficacy should be promoted in our nation and Arab world. Society and cultural limitations should be overcome by further research studies, intervention, and activism in the field of mental health systems in our nation and Arab countries to improve awareness.
使用手术治疗精神疾病是一种既定策略，尤其是在治疗严重且难治的强迫症方面。一些研究报告了立体定向手术有吸引力的解剖学和功能靶点。由于一些社会和文化限制，在我国和阿拉伯世界，精神疾病手术治疗被掩盖且鲜为人知，而这些限制应予以克服。我们在此报告我国首例精神神经外科手术以及我们如何克服此类社会限制。这是关于术后震颤的首例报告。
一名年轻患者患有严重且持续的强迫症，多年来对所有非手术治疗方式均无反应。在局部麻醉下进行了立体定向消融手术。文献中此前未见报道过精神神经外科手术后强迫症患者有明显改善且伴有自限性震颤的情况。手术前后用药相同，这并非药物性震颤。术后耶鲁布朗强迫症量表（YBOCS）显示改善了90%。
手术诱发的震颤可能是强迫症手术后的一种自限性副作用。在我国和阿拉伯世界应推广其安全性和有效性。我国和阿拉伯国家心理健康系统领域应通过进一步的研究、干预和行动主义来克服社会和文化限制，以提高认知度。
