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Psychiatric disorders in drug-resistant epileptic patients submitted to DBS
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Introdução O núcleo anterior do tálamo (ANT) é o alvo da estimulação cerebral profunda (DBS) no tratamento de pacientes com epilepsia refratária (RE). A ANT-DBS demonstrou eficácia no controlo de crises epiléticas. No entanto, surgiram referências a efeitos adversos, como distúrbios psiquiátricos. Objetivo Avaliar a progressão dos sintomas psiquiátricos e a manifestação de síndromes psiquiátricas de novo, em pacientes submetidos a ANT-DBS. Metodologia Pacientes adultos com RE submetidos a ANT-DBS no CHULN até abril de 2017, capazes de dar consentimento e realizar testes psicológicos, foram selecionados. A frequência das crises foi relatada pelo paciente/cuidador. Os sintomas psiquiátricos foram avaliados pelo Symptom Checklist-90 (SCL-90) previamente e 6, 12, 24, 36 e 60 meses após implantação. As síndromes psiquiátricas foram diagnosticadas pelo ICD-10. Resultados Dez pacientes foram incluídos. O tempo médio de seguimento clínico foi de 4.2 ± 1.17 anos. 70% dos pacientes relataram uma redução das crises. A mediana desta redução foi de 53% em 6 meses e 32.5% na última visita. Verificou-se um Índice Global de Severidade (GSI) basal médio no espectro disfuncional (1.12 ± 0.98), bem como um aumento neste índice e em todas as dimensões do SCL-90 no primeiro ano. Estes valores diminuíram posteriormente. Quatro pacientes (40%) foram diagnosticados com uma síndrome psiquiátrica de novo, dos quais dois tiveram um segundo tipo de episódio diferente, todos no primeiro ano após implantação. Conclusões Este estudo reforça o papel da ANT-DBS no controlo de crises em pacientes com RE e destaca o aumento no GSI de sintomas psiquiátricos e a alta frequência de síndromes psiquiátricas de novo, no primeiro ano. Apesar do pequeno tamanho da amostra, os resultados evidenciam a importância da avaliação psiquiátrica regular e atenta, a fim de proporcionar a melhor qualidade de vida possível a pessoas com RE submetidas a esta técnica de neuromodulação.
Introduction The anterior nucleus of the thalamus (ANT) is the target for deep brain stimulation (DBS) in the treatment of patients with refractory epilepsy (RE). ANT-DBS has shown efficacy in the control of epileptic seizures. However, references to adverse effects, such as psychiatric disorders, have emerged. Aim To evaluate psychiatric symptoms progression and the manifestation of de novo psychiatric syndromes over time, in patients undergoing ANT-DBS. Methodology Adult patients with RE who underwent ANT-DBS at the CHULN until April 2017, able to give consent and perform psychological tests, were selected for this study. The frequency of seizures was reported by the patient/caregiver. Psychiatric symptoms were assessed Symptom Checklist-90 (SCL-90) before, and 6, 12, 24, 36 and 60 months after implantation. Psychiatric syndromes were diagnosed by the ICD-10. Results Ten patients were included. Clinical follow-up mean time was 4.2 ± 1.17 years. 70% of patients reported a reduction of seizures. The median seizure reduction was 53% at 6 months and 32.5% at the last visit. A mean baseline Global Severity Index (GSI) in the dysfunctional spectrum was found (1.12 ± 0.98), plus an increase in this score and in all SCL-90 dimensions in the first year. These values subsequently decreased. Four patients (40%) were diagnosed with a de novo psychiatric syndrome, of which two had a second different type of episode, all in the first year after implantation. Conclusions This study reinforces the role of ANT-DBS in the control of seizures in patients with RE and highlights the GSI increase of psychiatric symptoms and high frequency of de novo psychiatric syndromes, in the first year. Despite the small sample size, these results show the significance of regular and attentive psychiatric evaluation of ANT-DBS patients, in order to provide the best possible quality of life to people with RE submitted to this neuromodulation technique.
Introduction The anterior nucleus of the thalamus (ANT) is the target for deep brain stimulation (DBS) in the treatment of patients with refractory epilepsy (RE). ANT-DBS has shown efficacy in the control of epileptic seizures. However, references to adverse effects, such as psychiatric disorders, have emerged. Aim To evaluate psychiatric symptoms progression and the manifestation of de novo psychiatric syndromes over time, in patients undergoing ANT-DBS. Methodology Adult patients with RE who underwent ANT-DBS at the CHULN until April 2017, able to give consent and perform psychological tests, were selected for this study. The frequency of seizures was reported by the patient/caregiver. Psychiatric symptoms were assessed Symptom Checklist-90 (SCL-90) before, and 6, 12, 24, 36 and 60 months after implantation. Psychiatric syndromes were diagnosed by the ICD-10. Results Ten patients were included. Clinical follow-up mean time was 4.2 ± 1.17 years. 70% of patients reported a reduction of seizures. The median seizure reduction was 53% at 6 months and 32.5% at the last visit. A mean baseline Global Severity Index (GSI) in the dysfunctional spectrum was found (1.12 ± 0.98), plus an increase in this score and in all SCL-90 dimensions in the first year. These values subsequently decreased. Four patients (40%) were diagnosed with a de novo psychiatric syndrome, of which two had a second different type of episode, all in the first year after implantation. Conclusions This study reinforces the role of ANT-DBS in the control of seizures in patients with RE and highlights the GSI increase of psychiatric symptoms and high frequency of de novo psychiatric syndromes, in the first year. Despite the small sample size, these results show the significance of regular and attentive psychiatric evaluation of ANT-DBS patients, in order to provide the best possible quality of life to people with RE submitted to this neuromodulation technique.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Epilepsia Núcleo anterior do tálamo-estimulação cerebral profunda Sintomas psiquiátricos Síndromes psiquiátricas Symptom checklist-90 Neurologia