Radiofrequency Ablation of the Ventromedial Shell of the Nucleus Accumbens as a Therapeutic Method Applied to Clozapine-Resistant Schizophrenia

Approximately 30% of the patients with treatment-resistant schizophrenia do not respond to clozapine, and approximately 25% do not tolerate its adverse effects, and there is no widely-accepted therapeutic consensus for these patients. In view of the refractoriness of a considerable percentage of patients to the antipsychotic treatment, other therapeutic modalities have become the object of study in the treatment of this disorder. Modulation with an inhibitory effect on the nucleus accumbens is based on the fact that this structure is necessary for the release of dopamine secondary to hippocampal activation, as well as the fact that the nucleus accumbens regulates the release of dopamine intrinsically and in the associative striatum, which is also involved in psychotic manifestations. Bilateral radiofrequency ablation of the ventromedial portion of the accumbens shell has already been performed in the treatment of refractory drug addiction, showing an adequate safety profile and a low rate of complications. Considering the pathophysiology of schizophrenia, the evidence of the preferential action of atypical antipsychotics on the ventromedial portion of the accumbens shell, the diversity of theories related to the mechanisms of resistance to antipsychotics, the promising results presented by the inhibitory modulation of the accumbens, and the safety profile and low complication rate of radiofrequency ablation of the ventromedial portion of the accumbens shell, it is reasonable to infer that this procedure is an admissible therapeutic proposal in the context of clozapine-resistant schizophrenia.