Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years
Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years
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DOI：
10.7916/d8m32tgm
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发表时间：
2013-11
影响因子：
2.2
通讯作者：
M. G. Motlagh;Megan E. Smith;A. Landeros-Weisenberger;A. Kobets;R. King;Joan Miravite;A. D. de Lotbinière;R. Alterman;A. Mogilner;M. Pourfar;M. Okun;J. Leckman
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文献类型：
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作者：
M. G. Motlagh;Megan E. Smith;A. Landeros-Weisenberger;A. Kobets;R. King;Joan Miravite;A. D. de Lotbinière;R. Alterman;A. Mogilner;M. Pourfar;M. Okun;J. Leckman
背景脑深部电刺激（DBS）仍然是一种实验性的，但有前途的治疗严重难治性抽动秽语综合征（TS）患者。有争议的问题包括患者的选择（年龄和临床表现），脑靶点的选择，以获得最佳的患者特异性结果，以及手术和刺激相关的严重不良事件的风险。方法本报告描述了我们对8例严重难治性恶性TS患者行DBS治疗的开放标签经验。将电极放置在丘脑中线核或苍白球、内侧部或两者中。使用改良Rush视频方案和耶鲁整体抽动严重程度量表（YGTSS）对所有患者术前和术后的抽动进行临床评估。结果虽然3例患者术后抽搐症状有明显改善（YGTSS改善>50%），但大多数患者的临床改善程度未达到这一水平。2例患者不得不取出DBS电极导线（1例是因为术后感染，另1例是因为缺乏受益）。讨论我们的临床经验支持迫切需要更多的数据和完善的干预措施和结果测量严重，恶性和药物难治性TS。由于TS不是一个病因同质的临床实体，DBS患者的入选标准和脑靶点的选择将需要更多的细化。
Background Deep brain stimulation (DBS) remains an experimental but promising treatment for patients with severe refractory Gilles de la Tourette syndrome (TS). Controversial issues include the selection of patients (age and clinical presentation), the choice of brain targets to obtain optimal patient-specific outcomes, and the risk of surgery- and stimulation-related serious adverse events. Methods This report describes our open-label experience with eight patients with severe refractory malignant TS treated with DBS. The electrodes were placed in the midline thalamic nuclei or globus pallidus, pars internus, or both. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video Protocol and the Yale Global Tic Severity Scale (YGTSS). Results Although three patients had marked postoperative improvement in their tics (>50% improvement on the YGTSS), the majority did not reach this level of clinical improvement. Two patients had to have their DBS leads removed (one because of postoperative infection and another because of lack of benefit). Discussion Our clinical experience supports the urgent need for more data and refinements in interventions and outcome measurements for severe, malignant, and medication-refractory TS. Because TS is not an etiologically homogenous clinical entity, the inclusion criteria for DBS patients and the choice of brain targets will require more refinement.