Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis
Deep Brain Stimulation for Tourette-Syndrome: A Systematic Review and Meta-Analysis
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DOI：
10.1016/j.brs.2015.11.005
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发表时间：
2016-03-01
影响因子：
7.7
通讯作者：
Kuhn, Jens
中科院分区：
文献类型：
--
作者：
Baldermann, Juan Carlos;Schueller, Thomas;Kuhn, Jens
背景资料：很大一部分患有抽动秽语综合征（TS）的患者在成年后继续经历症状，在严重的情况下，标准治疗无效。对于这些情况下，脑深部电刺激（DBS）正在成为一个有前途的治疗选择。目的：我们进行了系统的文献综述，以评估DBS治疗GTS的疗效。方法：病例报告和系列的个人数据进行汇总;耶鲁大学全球抽搐严重程度量表（YGTSS）被选为主要结局参数。总体而言，DBS导致YGTSS显著改善52.68%（IQR = 40.74，p < 0.001）。对照研究的分析显著支持刺激与关闭刺激，标准化平均差异为0.96（95% CI：0.36-1.56）。解开不同的目标点显示显着的YGTSS减少后刺激丘脑，苍白球腹外侧部和前内侧部，内囊和脑桥核的前肢，这些目标之间没有显着差异。一个显着的负相关性术前抽搐评分与丘脑stimulation.Conclusions的结果：尽管患者人数少，我们得出结论，DBS GTS是一个有效的选择，为医学上难以治愈的患者。不同的大脑目标导致了可比的改善率，表明了一个共同网络的调制。未来的研究可能会集中在更好地表征不同区域的临床效果，而不是寻找一个独特的目标。(C)2016 Elsevier Inc. All rights reserved.
Background: A significant proportion of patients with Tourette syndrome (TS) continue to experience symptoms across adulthood that in severe cases fail to respond to standard therapies. For these cases, deep brain stimulation (DBS) is emerging as a promising treatment option.Objective: We conducted a systematic literature review to evaluate the efficacy of DBS for GTS.Methods: Individual data of case reports and series were pooled; the Yale Global Tic Severity Scale (YGTSS) was chosen as primary outcome parameter.Results: In total, 57 studies were eligible, including 156 cases. Overall, DBS resulted in a significant improvement of 52.68% (IQR = 40.74, p < 0.001) in the YGTSS. Analysis of controlled studies significantly favored stimulation versus off stimulation with a standardized mean difference of 0.96 (95% CI: 0.36-1.56). Disentangling different target points revealed significant YGTSS reductions after stimulation of the thalamus, the posteroventrolateral part and the anteromedial part of the globus pallidus internus, the anterior limb of the internal capsule and nucleus accumbens with no significant difference between these targets. A significant negative correlation of preoperative tic scores with the outcome of thalamic stimulation was found.Conclusions: Despite small patient numbers, we conclude that DBS for GTS is a valid option for medically intractable patients. Different brain targets resulted in comparable improvement rates, indicating a modulation of a common network. Future studies might focus on a better characterization of the clinical effects of distinct regions, rather than searching for a unique target. (C) 2016 Elsevier Inc. All rights reserved.