Centromedian-Parafascicular Complex Deep Brain Stimulation for Tourette Syndrome: A Retrospective Study.
Centromedian-Parafascicular Complex Deep Brain Stimulation for Tourette Syndrome: A Retrospective Study.
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中央正中-束旁复合深部脑刺激治疗抽动秽语综合征：一项回顾性研究。
DOI：
10.1016/j.mayocp.2015.11.016
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发表时间：
2016
影响因子：
8.9
通讯作者：
Lee,KendallH
中科院分区：
文献类型：
--
作者：
Testini,Paola;Zhao,CongZ;Stead,Matt;Duffy,PenelopeS;Klassen,BryanT;Lee,KendallH
据报道，丘脑中央正中神经/束旁神经（CM-Pf）复合体的脑深部电刺激（DBS）是治疗重度、难治性抽动秽语综合征（TS）患者的一种有前景的治疗方法。在本研究中，对12例连续的难治性TS患者进行了双侧丘脑CM-Pf DBS的安全性和临床结局审查，其中11例患者符合我们机构至少2个月的术后随访标准。5例患者随访1年或更长时间。与许多TS患者一致，所有患者均患有精神病合并症。使用耶鲁全球抽动严重程度量表（YGTSS）测量了10名受试者随时间（平均26个月）的抽动严重程度和频率。1例患者仅在2周随访时接受检测，因此从YGTSS组分析中排除。最终YGTSS评分与术前基线评分有显著差异。总评分相对于基线的平均（n=10）改善为54%（95% CI，37-70）; YGTSS运动性抽搐、发声性抽搐和损伤子测试相对于基线的平均改善分别为46%（95% CI，34-64）、52%（95% CI，34-72）和59%（95% CI，39-78）。无术中并发症。术后，1例受试者因头皮糜烂和伤口感染接受了伤口翻修;通过手术翻修和联合抗生素治疗成功挽救了植入的DBS系统。刺激引起的不良反应并未阻止DBS系统的使用，尽管1例受试者正在接受刺激器关闭的试验期。该手术系列增加了关于CM-Pf DBS的文献，并支持其作为严重难治性TS的有效和安全的治疗选择。
Deep brain stimulation (DBS) of the thalamic centromedian/parafascicular (CM-Pf) complex has been reported as a promising treatment for patients with severe, treatment-resistant Tourette syndrome (TS). In this study, safety and clinical outcomes of bilateral thalamic CM-Pf DBS were reviewed in a series of 12 consecutive patients with medically refractory TS, 11 of whom met the criteria of postsurgical follow-up at our institution for at least 2 months. Five patients were followed for a year or longer. Consistent with many patients with TS, all patients had psychiatric comorbidities. Tic severity and frequency were measured by using the Yale Global Tic Severity Scale (YGTSS) over time (average, 26 months) in 10 subjects. One patient was tested at 2-week follow-up only and thus was excluded from group YGTSS analysis. Final YGTSS scores differed significantly from the preoperative baseline score. The average (n=10) improvement relative to baseline in the total score was 54% (95% CI, 37-70); average improvement relative to baseline in the YGTSS Motor tic, Phonic tic, and Impairment subtests was 46% (95% CI, 34-64), 52% (95% CI, 34-72), and 59% (95% CI, 39-78), respectively. There were no intraoperative complications. After surgery, 1 subject underwent wound revision because of a scalp erosion and wound infection; the implanted DBS system was successfully salvaged with surgical revision and combined antibiotic therapy. Stimulation-induced adverse effects did not prevent the use of the DBS system, although 1 subject is undergoing a trial period with the stimulator off. This surgical series adds to the literature on CM-Pf DBS and supports its use as an effective and safe therapeutic option for severe refractory TS.