Long-Term Follow-Up of MRI-Guided Bilateral Anterior Capsulotomy in Patients with Refractory Schizophrenia

Aim: To determine whether there is a long-term benefit of MRI-guided bilateral anterior capsulotomy in the treatment of refractory schizophrenia. Methods: 116 patients (16 patients did not complete the follow-up evaluation) with refractory schizophrenia who underwent capsulotomy were included. The treatment effect was evaluated using a series of international rating scales. Evaluations were performed at baseline, 3 weeks and 24 months after surgery. Results:The rate of effectiveness was 74% according to the Clinical Global Impression evaluation, and there was an obvious improvement based on the statistical analysis for Positive and Negative Symptom Scale (baseline vs. 24 months after surgery, 6.86 +/- 8.12, 10.70 +/- 8.70 vs. 26.65 +/- 4.85, 21.66 +/- 7.19), Brief Psychiatric Rating Scale (14.75 +/- 13.21 vs. 44.97 +/- 9.36), Activities of Daily Living Scale (18.06 +/- 6.58 vs. 24.61 +/- 8.95), Social Disability Screening Schedule (6.69 +/- 6.12 vs. 15.06 +/- 3.18) and Global Assessment Scale (74.35 +/- 12.75 vs. 48.74 +/- 9.18). Among all the symptoms of schizophrenia, aggressive behavior (82% response rate), hallucination, (71% response rate) and delusion (70% response rate) showed the best response. Conclusion: Our research indicates that capsulotomy is a relatively safe and effective intervention for patients with refractory schizophrenia. It could be an alternative therapy for those patients with chronic and severe schizophrenia. But there must be strict inclusion criteria considering the complications and irreversibility of this procedure. (C) 2014 S. Karger AG, Basel