Salcedo-Moreno Juan Camilo, Peralta-Pizza Fernando, Vélez-Jimenez Paola, Arteaga-Ortiz David, Villegas-Trujillo Lina María, Escobar-Vidarte Oscar Andrés
Sección de Neurocirugía, Universidad del Valle, Cali, Colombia.
Sección de Neurocirugía, Universidad Javeriana, Cali, Colombia.
Braz J Psychiatry. 2024;46:e20243582. doi: 10.47626/1516-4446-2024-3582. Epub 2024 Sep 19.
To identify the effects of amygdala neuromodulation on disruptive behavior and quality of life changes in patients and its relationship with epilepsy.
The MEDLINE, OVID, WoS, Central Cochrane, and Scopus databases were systematically searched up to March 2023 for studies with at least six months of follow-up on extremely aggressive patients who underwent ablative surgeries or deep brain stimulation of the amygdala as the unique therapeutic target.
The search yielded 1,352 studies after excluding duplicates. However, only 11 case series and three case reports met the inclusion criteria. The studies were published between 1963 and 2023 and included 1,033 patients, mostly male, aged between 5 and 61 years. All of the studies performed amygdalotomy except one, which performed deep brain stimulation. Behavior improved in > 70% of the patients, and seizures occurred in approximately 30%, of whom 40% presented improvement. Two studies reported worsening behavior.
Although we found that amygdalotomy has a positive effect on patient behavior and seizure control, new studies with greater power are needed. Future studies should investigate deep brain stimulation and the role of connectomics regarding this brain structure.
确定杏仁核神经调节对患者破坏性行为和生活质量变化的影响及其与癫痫的关系。
系统检索MEDLINE、OVID、WoS、Cochrane中心和Scopus数据库，截至2023年3月，查找对接受以杏仁核为唯一治疗靶点的切除手术或深部脑刺激的极端攻击性患者进行至少六个月随访的研究。
排除重复项后共检索到1352项研究。然而，只有11个病例系列和3个病例报告符合纳入标准。这些研究发表于1963年至2023年之间，共纳入1033例患者，大多数为男性，年龄在5至61岁之间。除1项进行深部脑刺激的研究外，所有研究均进行了杏仁核切开术。超过70%的患者行为得到改善，约30%的患者出现癫痫发作，其中40%的患者癫痫发作情况有所改善。两项研究报告了行为恶化情况。
尽管我们发现杏仁核切开术对患者行为和癫痫控制有积极作用，但仍需要更有说服力的新研究。未来的研究应探讨深部脑刺激以及连接组学在该脑结构中的作用。
