학술논문

Case Series: Unilateral Amygdala Ablation Ameliorates Post-Traumatic Stress Disorder Symptoms and Biomarkers
RESEARCH--HUMAN--CLINICAL STUDIES
Document Type
Academic Journal
Source
Neurosurgery. October 2020, Vol. 87 Issue 4, p796, 7 p.
Subject
Care and treatment
Development and progression
Health aspects
Lamotrigine -- Health aspects
Ablation (Surgery) -- Health aspects
Epilepsy -- Care and treatment -- Development and progression
Seizures (Medicine) -- Development and progression -- Care and treatment
Post-traumatic stress disorder -- Development and progression -- Care and treatment
Biological markers -- Health aspects
Language
English
ISSN
0148-396X
Abstract
Post-traumatic stress disorder (PTSD) is a severe psychobiological disorder that can develop after experiencing an event that causes or threatens serious harm. It is estimated to affect 6% to 8% [...]
BACKGROUND: Post-traumatic stress disorder is a severe psychobiological disorder associated with hyperactivity of the amygdala, particularly on the right side. Highly selective laser ablation of the amygdalohippocampal complex is an effective neurosurgical treatment for medically refractory medial temporal lobe epilepsy that minimizes neurocognitive deficits relative to traditional open surgery. OBJECTIVE: To examine the impact of amygdalohippocampotomy upon symptoms and biomarkers of post-traumatic stress disorder. METHODS: Two patients with well-documented chronic post-traumatic stress disorder who subsequently developed late-onset epilepsy underwent unilateral laser amygdalohippocampotomy. Prospective clinical and neuropsychological measurements were collected in patient 1. Additional prospective measurements of symptoms and biomarkers were collected pre- and post-surgery in patient 2. RESULTS: After laser ablation targeting the nondominant (right) amygdala, both patients experienced not only reduced seizures, but also profoundly abated post-traumatic stress symptoms. Prospective evaluation of biomarkers in patient 2 showed robust improvements in hyperarousal symptoms, fear potentiation of the startle reflex, brain functional magnetic resonance imaging responses to fear-inducing stimuli, and emotional declarative memory. CONCLUSION: These observations support the emerging hypothesis that the right amygdala particularly perpetuates the signs and symptoms of post-traumatic stress disorder and suggests that focal unilateral amydalohippocampotomy can provide therapeutic benefit. KEY WORDS: Anxiety, Amygdala, Hippocampus, Resection, Lesion, Ablation, Epilepsy, Post-traumatic stress disorder