Reversible Psychiatric Adverse Effects Related to Deep Brain Stimulation of the Anterior Thalamus in Patients With Refractory Epilepsy Järvenpää S, Peltola J, Rainesalo S, et al. Epilepsy Behav. 2018;88:373-379. OBJECTIVE Anterior nucleus of thalamus (ANT) deep brain stimulation (DBS) is becoming a more common treatment for drug-resistant epilepsy. Epilepsy and depression display a bidirectional association. Anterior nucleus of thalamus has connections to anterior cingulate cortex and orbitomedial prefrontal cortex, hence, a possible role in emotional and executive functions, and thus, ANT DBS might exert psychiatric adverse effects. Our aim was to evaluate previous and current psychiatric symptoms in patients with epilepsy undergoing ANT DBS surgery and assess the predictability of psychiatric adverse effects. Programming-related psychiatric adverse effects are also reported. METHOD Twenty-two patients with ANT DBS for retractable epilepsy were examined, and a psychiatric evaluation of depressive and other psychiatric symptoms was performed with Montgomery-Åsberg Depression Rating Scale, Beck Depression Inventory, and Symptom Checklist prior to surgery, concentrating on former and current psychiatric symptoms and medications. The follow-up visit was 1 year after surgery. RESULTS At the group level, no changes in mood were observed during ANT DBS treatment. Two patients with former histories of depression experienced sudden depressive symptoms related to DBS programming settings; these were quickly alleviated after changing the stimulation parameters. In addition, 2 patients with no previous histories of psychosis gradually developed clear paranoid and anxiety symptoms that also relieved slowly after changing the programming settings. CONCLUSION The majority of our ANT DBS patients did not experience psychiatric adverse effects. Certain DBS parameters might predispose to sudden depressive or slowly manifesting paranoid symptoms that are reversible via programming changes.

中文翻译：

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寻找最佳点：微调 DBS 参数以治疗癫痫发作，同时避免精神并发症。

与难治性癫痫患者前丘脑深部脑刺激相关的可逆精神病学副作用 Järvenpää S、Peltola J、Rainesalo S 等。癫痫行为。2018；88:373-379。目的 丘脑前核 (ANT) 深部脑刺激 (DBS) 正在成为耐药性癫痫更常见的治疗方法。癫痫和抑郁症表现出双向关联。丘脑前核与前扣带皮层和眶内侧前额叶皮层有联系，因此可能在情绪和执行功能中发挥作用，因此，ANT DBS 可能会产生精神方面的不良影响。我们的目的是评估接受 ANT DBS 手术的癫痫患者以前和当前的精神症状，并评估精神不良反应的可预测性。还报告了与编程相关的精神不良反应。方法 对 22 例 ANT DBS 患者的可回缩性癫痫进行检查，并在手术前使用 Montgomery-Åsberg 抑郁评定量表、贝克抑郁量表和症状检查表对抑郁和其他精神症状进行精神评估，重点关注既往和现在精神症状和药物。术后随访1年。结果 在组水平上，在 ANT DBS 治疗期间没有观察到情绪变化。两名有抑郁病史的患者突然出现与 DBS 编程设置相关的抑郁症状；这些在改变刺激参数后很快得到缓解。此外，2 名既往无精神病史的患者逐渐出现明显的偏执和焦虑症状，在改变编程设置后也缓慢缓解。结论 我们的大多数 ANT DBS 患者没有出现精神方面的不良反应。某些 DBS 参数可能会导致突然的抑郁或缓慢表现出的偏执症状，这些症状可通过编程更改来逆转。