Supplementary Material for: Electroencephalography in Psychiatric Surgery: Past Use and Future Directions

The last two decades have seen a re-emergence of surgery for intractable psychiatric disease, in large part due to increased use of deep brain stimulation. The development of more precise, image-guided, less invasive interventions has improved the safety of these procedures, even though the relative merits of modulation at various targets remain under investigation. With an increase in the number and type of interventions for modulating mood/anxiety circuits, the need for biomarkers to guide surgeries and predict treatment response is as critical as ever. Electroencephalography (EEG) has a long history in clinical neurology, cognitive neuroscience, and functional neurosurgery, but has limited prior usage in psychiatric surgery. MEDLINE, Embase, and Psyc-INFO searches on the use of EEG in guiding psychiatric surgery yielded 611 articles, which were screened for relevance and quality. We synthesized three important themes. First, considerable evidence supports EEG as a biomarker for response to various surgical and non-surgical therapies, but large-scale investigations are lacking. Second, intraoperative EEG is likely more valuable than surface EEG for guiding target selection, but comes at the cost of greater invasiveness. Finally, EEG may be a promising tool for objective functional feedback in developing “closed-loop” psychosurgeries, but more systematic investigations are required.

近二十年来，难治性精神疾病手术治疗再度兴起，这在很大程度上得益于脑深部电刺激（deep brain stimulation）技术应用的增多。随着更为精准、影像引导且微创的手术干预手段的发展，此类手术的安全性得以提升，尽管不同靶点的神经调控相对优劣仍有待研究验证。随着用于调控情绪/焦虑环路的手术干预手段在数量与类型上的增加，对用于指导手术、预测治疗反应的生物标志物（biomarker）的需求也与日俱增。脑电图（Electroencephalography, EEG）在临床神经病学、认知神经科学与功能神经外科领域拥有悠久的应用历史，但此前在精神外科手术中的应用却十分有限。针对脑电图在精神外科手术指导中的应用，我们通过MEDLINE、Embase及PsycINFO数据库进行文献检索，共获得611篇相关文献，随后对这些文献的相关性与质量进行了筛选。我们归纳总结出三大核心研究主题：其一，现有大量证据表明脑电图可作为各类手术与非手术治疗反应的生物标志物，但相关大规模研究仍有所欠缺；其二，在指导靶点选择方面，术中脑电图（intraoperative EEG）相较于头皮脑电图（surface EEG）更具应用价值，但这一优势伴随着更高的侵入性代价；其三，在开发"闭环（closed-loop）"精神外科手术的过程中，脑电图或可成为客观功能反馈的有效工具，但仍需开展更多系统性研究。