Servello D, Porta M, Sassi M, Brambilla A, Robertson M M
Neurosurgical Division, Istituto Galeazzi IRCCS, via Galeazzi 4, 20161 Milano, Italy.
J Neurol Neurosurg Psychiatry. 2008 Feb;79(2):136-42. doi: 10.1136/jnnp.2006.104067. Epub 2007 Sep 10.
There have been several reports of successful deep brain stimulation (DBS) for the treatment of severe Gilles de la Tourette syndrome (GTS).
18 cases of GTS who were resistant to at least 6 months of standard and innovative treatments, as well as to psychobehavioural techniques, underwent DBS. DBS was placed bilaterally in the centromedian-parafascicular (CM-Pfc) and ventralis oralis complex of the thalamus. Patients were evaluated after surgery, with immediate and formal assessments at least every 3 months, including "on-off" and "sham off" in the first nine patients.
All patients responded well to DBS, although to differing degrees. The duration of follow-up assessments ranged from 3 to 18 months. The comorbid symptoms of obsessive-compulsive behaviour, obsessive-compulsive disorder, self-injurious behaviours, anxiety and premonitory sensations decreased after treatment with DBS. There were no serious permanent adverse effects.
DBS is a useful and safe treatment for severe GTS. The results of ours and previous DBS reports suggest that the CM-Pfc and ventralis oralis complex of the thalamus may be a good DBS target for GTS.
已有多篇关于成功运用脑深部电刺激术（DBS）治疗重度抽动秽语综合征（GTS）的报道。
18例对至少6个月的标准及创新治疗以及心理行为技术均耐药的GTS患者接受了DBS治疗。DBS双侧植入丘脑中央中-束旁核（CM-Pfc）及丘脑腹前复合体。术后对患者进行评估，最初9例患者至少每3个月进行一次即时和正式评估，包括“开-关”和“假刺激关闭”评估。
所有患者对DBS均有良好反应，尽管程度不同。随访评估时间为3至18个月。经DBS治疗后，强迫行为、强迫症、自伤行为、焦虑及先兆感觉等共病症状有所减轻。未出现严重的永久性不良反应。
DBS是治疗重度GTS的一种有效且安全的方法。我们的研究结果及之前的DBS报道表明，丘脑CM-Pfc及腹前复合体可能是GTS较好的DBS靶点。
