Stereotactic multi-target limbic leucotomy for treating intractable psychiatric disease in 30 patients Three-year follow-up of memory, intelligence, and psychiatric symptoms

摘要

BACKGROUND: The biochemical hypothesis of dopamine hyperfunction in the brain can explain the pathological mechanisms of schizophrenia. Surgery is performed based on limbic system circuit theory correspondence to above-mentioned hypothesis. Stereotactic surgery for the treatment of mental disorders is related to stereotactic surgery that influences the Papez circuit. OBJECTIVE: To observe the effects of stereotactic multi-target limbic leucotomy on the improvements in memory, intelligence and psychiatric symptoms in the treatment of intractable psychiatric disease. DESIGN: Self-control case analysis and follow-up of therapeutic effects. SETTING: Department of Neurosurgery, First Hospital, Hebei Medical University. PARTICIPANTS: Thirty patients with intractable psychiatric disease, who received stereotactic surgery in the Department of Neurosurgery, First Hospital, Hebei Medical University between July 2002 and August 2005, were included in this study. The patients, 21 males and 9 females, all met the diagnostic criteria of intractable psychiatric disease, determined by the national psychosurgery cooperation team in 1998. Informed consents for surgery and clinical follow-up exams were obtained from patients and/or patients' relatives (guardians). METHODS: In 30 patients with intractable psychiatric disease, limbic leucotomy was performed by stereotactic technique. Multi-target radiofrequency hyperthermia was performed in the intracranial amygdaloid nucleus, anterior limb of internal capsule, callosal gyrus, among other regions. The therapeutic effects of patients were evaluated by Brief Psychiatric Rating Scale (BPRS) before surgery, and 6 months, 1, and 3 years after surgery. The Wechsler Adult Intelligence Scale (WAIS) and Clinical Memory Scale (CMS) were used to assess memory and intelligence before and after surgery. MAIN OUTCOME MEASURES: Memory, intelligence, and psychiatric symptoms of patients before and after operation. RESULTS: Thirty patients were included in the final analysis. ① Memory and intelligence changes of patients: CMS and WAIS showed there were no significant differences in the changes of brain functions before and after operation (P > 0.05). ② Improved degree of symptoms: 5 patients were cured, 8 patients significantly improved, 8 patients improved, 3 patients had no changes, and 6 patients had recurrent symptoms. CONCLUSION: Stereotactic multi-target limbic leucotomy can improve the symptoms of patients with intractable psychiatric disease. Follow-up results showed that memory and intelligence were not noticeably improved after surgery.