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DOI: 10.1055/s-0040-1702978
Neurosurgery for Refractory Schizophrenia: A Systematic Literature Review
Neurocirurgia para esquizofrenia refratária: Uma revisão sistemática da literaturaPublication History
10 June 2019
11 December 2019
Publication Date:
06 April 2020 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00028832/202002/lookinside/thumbnails/10-1055-s-0040-1702978_1900035-1.jpg)
Abstract
Schizophrenia is a chronic and disabling psychiatric disease that can be refractory to conventional treatment. The present study aims to gather information about the circuitry related to schizophrenia to describe possible surgical targets, and to establish whether psychosurgery can be a safe and effective treatment option for refractory schizophrenia. A systematic review of the literature was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. An electronic search was performed in the Pubmed and BVSalud databases using medical subject headings (MeSH) combined with Boolean operators. Out of the 724 studies retrieved, 13 were included in the review. Regarding leucotomy without a stereotactic approach, we found side effects such as irritability, nervous excitement, cases of disinhibition, and compromised normal social control. In other stereotactic procedures, there was some improvement, mainly regarding aggressiveness and positive symptoms; an anterior capsulotomy had an efficacy rate of 74% according to the Clinical Global Impression (CGI) rating scales. The only deep brain stimulation (DBS) case report found in our study described a significant improvement in the positive and negative symptoms. The use of a stereotactic approach enables psychosurgery to be a safe and effective treatment option in cases of refractory schizophrenia, improving the quality of life and the symptoms. Cognitive and negative symptoms remain a challenge in the treatment of schizophrenia, revealing that more targets in the circuitry must be surgically explored. Furthermore, more clinical trials are needed to compare these many surgical techniques and targets, using a standard evaluation parameter. The results show that DBS has a promising future in the treatment of refractory schizophrenia.
Resumo
A esquizofrenia é uma doença psiquiátrica crônica e incapacitante, que pode ser refratária ao tratamento convencional Este estudo tem como objetivo coletar informações sobre a circuitaria relacionada à esquizofrenia, descrever possíveis alvos cirúrgicos, e estabelecer se a psicocirurgia pode ser uma opção de tratamento segura e eficaz para a esquizofrenia refratária. Uma revisão sistemática da literatura foi realizada de acordo com a recomendação Itens Preferidos para Relatar Revisões Sistemáticas e Meta-análises (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA, em inglês). Uma busca eletrônica foi realizada nas bases de dados Pubmed e BVSalud, e, de 724 estudos coletados, 13 foram incluídos na revisão. Com relação à leucotomia sem abordagem estereotáxica, foram encontrados efeitos colaterais como irritabilidade, excitação nervosa, e casos de desinibição e comprometimento do controle social normal. Em outros procedimentos estereotáxicos, houve alguma melhora, principalmente na agressividade e nos sintomas positivos. A capsulotomia anterior apresentou taxa de eficácia de 74% de acordo com as escalas de Impressão Clínica Global (Clinical Global Impression, CGI, em inglês). No único relato de caso de estimulação cerebral profunda (ECP) encontrado em nosso estudo os autores descreveram uma melhora significativa nos sintomas positivos e negativos. O uso da abordagem estereotáxica permite que a psicocirurgia seja uma opção de tratamento segura e eficaz para a esquizofrenia refratária. Os sintomas cognitivos e negativos permanecem um desafio no tratamento da esquizofrenia, revelando que mais alvos devem ser explorados cirurgicamente. Além disso, mais ensaios clínicos são necessários para comparar essas várias técnicas e alvos cirúrgicos, segundo parâmetro comum de avaliação. Os resultados mostram que a ECP tem um futuro promissor no tratamento da esquizofrenia refratária.
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