Unilateral amygdala ablation: a potential treatment option for severe chronic post-traumatic stress disorder (PTSD)?
Unilateral amygdala ablation: a potential treatment option for severe chronic post-traumatic stress disorder (PTSD)?
复制标题
单侧杏仁核消融：严重慢性创伤后应激障碍（PTSD）的潜在治疗选择？
DOI：
10.1080/14737175.2023.2218034
复制
发表时间：
2023
影响因子：
4.3
通讯作者：
vanRooij,SanneJH
中科院分区：
文献类型：
--
作者：
Teye-Botchway,Lois;Willie,JonT;vanRooij,SanneJH
创伤后应激障碍（PTSD）是一种使人衰弱的障碍，当精神症状，如闪回、噩梦和过度觉醒，在暴露于创伤事件后出现时发生。不幸的是，创伤后应激障碍的诊断和创伤暴露在今天的许多社区都很普遍。大约70%的成年人至少经历过一次创伤性事件，终生PTSD估计在6%到9%之间，在高危人群或资源匮乏人群中报告的水平甚至更高[1-3]。数据显示，在我们的社区中，PTSD发病率的上升构成了一种公共健康危机，需要更多的关注、研究和更好的治疗。虽然推荐的创伤后应激障碍治疗，如创伤集中治疗，有或没有药物治疗，对一些患者是成功的，但研究发现，大约30-50%的创伤后应激障碍患者对目前的治疗方案没有反应，这说明了开发治疗这种疾病的新方法和途径的重要性。有趣的是，功能性磁共振成像（fMRI）研究表明，杏仁核可能是创伤后应激障碍治疗无反应[5]的决定性因素。杏仁核是一个涉及情绪处理和联想恐惧学习的大脑结构。杏仁核有许多重要的激活中心，用于处理常见的创伤后应激障碍症状，如恐惧感、战斗/逃跑反应和过度觉醒（例如，警惕）。我们和其他人发现，杏仁核的高反应性，特别是右脑，预示着PTSD症状的发展、严重程度和治疗无反应[5-9]。这些发现是否表明杏仁核高反应性在PTSD症状维持和治疗无反应中的因果作用尚不清楚。然而，令人鼓舞的消息是，我们在2020年发表的一个病例系列中发现了我们目前对杏仁核与创伤后应激障碍之间联系的理解的重大进展。在这个系列中，切除右侧杏仁核和癫痫性海马体与PTSD症状的明显改善有关。医学难治性内侧颞叶癫痫合并PTSD 2例
Post-traumatic stress disorder (PTSD) is a debilitating disorder that occurs when psychiatric symptoms, such as flashbacks, nightmares, and hyperarousal, develop after exposure to a traumatic event. Unfortunately, PTSD diagnoses and trauma exposure are prevalent in many communities today. About 70% of adults have experienced a traumatic event at least once, and lifetime PTSD estimates range between 6% and 9%, with even higher levels reported in at-risk or lowresourced populations [1–3]. Data shows that the increasing rates of PTSD in our communities constitute a public health crisis that warrants more attention, research, and better treatment. Although the recommended PTSD treatments, such as trauma-focused therapy, with or without medication, are successful for some patients, studies have found that about 30–50% of PTSD patients do not respond to current treatment options [4], which illustrates the importance of developing new methods and ways of treating this disorder. Interestingly, functional magnetic resonance imaging (fMRI) studies have shown that the amygdala could be a determining factor behind PTSD treatment non-response [5]. The amygdala is a brain structure involved in emotion processing and associative fear learning. The amygdala has many essential activation centers for common PTSD symptoms, such as the feeling of fear, the fight/flight response, and hyperarousal (for example, being on guard). We and others have found that amygdala hyper-reactivity, particularly in the right brain hemisphere, predicts PTSD symptom development, severity, and treatment non-response [5–9]. Whether these findings indicate a causal role of amygdala hyper-reactivity in PTSD symptom maintenance and treatment non-response is less understood.In promising news, however, a significant development in our current understanding of the link between the amygdala and PTSD was found in a case series we published in 2020. In this series, ablating the right amygdala along with an epileptic hippocampus was associated with unambiguous improvements in PTSD symptoms [10]. Two patients with medically refractory medial temporal lobe epilepsy with comorbid PTSD