Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus
Motor Improvement and Emotional Stabilization in Patients With Tourette Syndrome After Deep Brain Stimulation of the Ventral Anterior and Ventrolateral Motor Part of the Thalamus
复制标题
DOI：
10.1016/j.biopsych.2014.05.014
复制
发表时间：
2016-03-01
影响因子：
10.6
通讯作者：
Kuhn, Jens
中科院分区：
文献类型：
--
作者：
Huys, Daniel;Bartsch, Christina;Kuhn, Jens
背景技术背景：自1999年首次应用以来，脑深部电刺激（DBS）在减轻其他治疗难治性抽动秽语综合征（TS）症状方面的潜在受益已在多篇出版物中记录。然而，关于理想的神经靶点的不确定性仍然存在，并且迄今为止未记录但可能对人格产生长期负面影响的可能性引发了关于DBS伦理影响的辩论。在这项前瞻性开放标签试验中，（三名女性，5名男性），19-56岁，患有严重和药物难治性TS，丘脑腹前和腹外侧运动部分的频率DBS。评估TS的过程中，其临床合并症，人格参数，自我感知的生活质量，患者进行了重复的精神病学评估，在基线和6和12个月后DBS onset.RESULTS：分析表明，DBS的TS症状，特质焦虑，生活质量和全球功能的一个明显的低副作用配置文件的显著和有益的影响。此外，术前强迫症，焦虑，情绪调节障碍，抑制似乎是显着的预测因素的手术outcome.CONCLUSIONS：权衡电机的影响和理想的副作用对手术相关的风险和负面影响，刺激丘脑腹前和腹外侧电机部分时，考虑DBS TS似乎是一个有价值的选择。
BACKGROUND: Since its first application in 1999, the potential benefit of deep brain stimulation (DBS) in reducing symptoms of otherwise treatment-refractory Tourette syndrome (TS) has been documented in several publications. However, uncertainty regarding the ideal neural targets remains, and the eventuality of so far undocumented but possible negative long-term effects on personality fuels the debate about the ethical implications of DBS.METHODS: In this prospective open-label trial, eight patients (three female, five male) 19-56 years old with severe and medically intractable TS were treated with high-frequency DBS of the ventral anterior and ventrolateral motor part of the thalamus. To assess the course of TS, its clinical comorbidities, personality parameters, and self-perceived quality of life, patients underwent repeated psychiatric assessments at baseline and 6 and 12 months after DBS onset.RESULTS: Analysis indicated a strongly significant and beneficial effect of DBS on TS symptoms, trait anxiety, quality of life, and global functioning with an apparently low side-effect profile. In addition, presurgical compulsivity, anxiety, emotional dysregulation, and inhibition appeared to be significant predictors of surgery outcome.CONCLUSIONS: Trading off motor effects and desirable side effects against surgery-related risks and negative implications, stimulation of the ventral anterior and ventrolateral motor part of the thalamus seems to be a valuable option when considering DBS for TS.