Visser-Vandewalle V
Department of Neurosurgery, University Hospital Maastricht, Maastricht, The Netherlands.
Acta Neurochir Suppl. 2007;97(Pt 2):215-22. doi: 10.1007/978-3-211-33081-4_24.
Tourette syndrome is a neuropsychiatric disorder with onset in early childhood and characterized by tics, often associated with behavioural abnormalities. Symptoms often disappear before or during adulthood. Treatment consists of psychotherapy or pharmacotherapy. A small percentage of patients is treatment refractory. After the introduction of deep brain stimulation (DBS) of the thalamus as a new therapeutical approach in 1999, several other brain nuclei have been targeted in a small number of patients, like the globus pallidus internus, anteromedial and ventroposterolateral part, and the nucleus accumbens. In the published reports, a tic reduction rate of at least 66% is described. The effects of DBS on associated behavioural disorders are more variable. The number of treated patients is small and it is unclear whether the effects of DBS are dependent on the target nucleus. The pathophysiology of Tourette syndrome is not well understood. On the basis of our current knowledge of cortico-basal ganglia-thalamocortical circuits, an explanation for the beneficial effects of DBS on tics is proposed. It is concluded that a meticulous evaluation of the electrode position, and a blinded assessment of the clinical effects on tics and behavioural disorders, is absolutely mandatory in order to identify the best target of DBS for Tourette syndrome.
抽动秽语综合征是一种神经精神障碍，起病于儿童早期，以抽动为特征，常伴有行为异常。症状通常在成年前或成年期消失。治疗包括心理治疗或药物治疗。一小部分患者对治疗无效。自1999年丘脑深部脑刺激（DBS）作为一种新的治疗方法引入以来，少数患者的其他脑核也成为靶点，如苍白球内侧部、前内侧和腹后外侧部以及伏隔核。在已发表的报告中，描述了至少66%的抽动减少率。DBS对相关行为障碍的影响则更具变异性。接受治疗的患者数量较少，目前尚不清楚DBS的效果是否取决于靶点核团。抽动秽语综合征的病理生理学尚未完全了解。基于我们目前对皮质-基底神经节-丘脑皮质环路的认识，提出了DBS对抽动有益作用的一种解释。得出的结论是，为了确定DBS治疗抽动秽语综合征的最佳靶点，对电极位置进行细致评估以及对抽动和行为障碍的临床效果进行盲法评估是绝对必要的。
