Functional Neurosurgery Unit, Tourette Syndrome and Movement Disorder Center, Istituto Galeazzi IRCCS, Milan, Italy.
Neuromodulation. 2010 Jul;13(3):187-94. doi: 10.1111/j.1525-1403.2009.00253.x. Epub 2009 Nov 20.
This study aimed to assess the long-term results of deep brain stimulation (DBS) for patients affected with Gilles de la Tourette syndrome, documenting refractoriness to conservative treatments.
Starting from November 2004, 36 patients diagnosed with a Tourette syndrome refractory to conventional and innovative treatments (refractory Tourette syndrome) were operated on for DBS positioning at our dedicated Tourette Clinic. A total number of 79 procedures were carried out: 67 at the thalamic intralaminar/ventralis oralis (Vo/CM-Pf) target, 2 at the posterior Gpi, and 10 at the nucleus accumbens. The target of the DBS procedure was chosen on the basis of clinical manifestations expressed by the single patient. Six out of the ten procedures centered at the Nucleus Accumbens were undertaken on the basis of a persistent behavioral comorbidity in spite of a good response over tic frequency and severity after a first DBS procedure (two interventions at the Vo/CM-Pf and one at the Gpi, bilaterally).
All the patients were treated bilaterally except one, treated at the right Vo/CM-Pf because of vascular physiologic abnormalities at the left hemisphere. Two patients refused further treatments after DBS intervention (one of them requiring and obtaining complete removal of the DBS implant with no postsurgical complications documented) and were excluded from follow-up evaluation. Statistically significant improvements were reached for all the other patients concerning the evaluation scales used (Yale Global Tic Severity Scale, Beck Depression Inventory, State-Trait Anxiety Inventory, Yale-Brown Obsessive Compulsive Scale, and a 10-point visual analog scale for self-evaluation of the impact of TS on social integration of the patient).
Gilles de la Tourette syndrome is a complex neuropsychiatric disorder with a significant prevalence in the general population. More than 50% of the patients with TS present a behavioral comorbidity, and anxiety and depression are, to various degrees, associated to this "waxing and waning" clinical picture. DBS in our experience proved to be a valid treatment modality for those patients who fail to respond to conservative treatment modalities. A multidisciplinary team is nevertheless necessary to properly handle this complex therapeutic option.
本研究旨在评估深部脑刺激（DBS）治疗对伴有 Gilles de la Tourette 综合征（Gilles de la Tourette syndrome）且对保守治疗无反应的患者的长期疗效，这些患者均符合难治性 Gilles de la Tourette 综合征（refractory Gilles de la Tourette syndrome）的诊断标准。
自 2004 年 11 月起，我们在专门的 Gilles de la Tourette 诊所为 36 例经常规和创新治疗（refractory Gilles de la Tourette syndrome）后仍无反应的 Gilles de la Tourette 综合征患者进行 DBS 定位手术。总共进行了 79 次手术：67 次在丘脑内板/腹侧口（Vo/CM-Pf）靶点，2 次在后 Gpi，10 次在伏隔核。DBS 手术的目标是根据每位患者的临床表现来选择。10 次在伏隔核的手术中有 6 次是在首次 DBS 手术后 Tic 频率和严重程度虽有改善，但仍存在持续性行为共病的基础上进行的（2 次在 Vo/CM-Pf，1 次在 Gpi，双侧）。
除 1 例外，所有患者均接受双侧治疗，该患者因左侧半球血管生理异常而仅在右侧 Vo/CM-Pf 接受治疗。2 例患者在 DBS 干预后拒绝进一步治疗（其中 1 例要求并获得了 DBS 植入物的完全移除，且未记录到术后并发症），并被排除在随访评估之外。所有其他患者在使用的评估量表上均达到了统计学上的显著改善（耶鲁综合 Tic 严重程度量表、贝克抑郁量表、状态特质焦虑量表、耶鲁-布朗强迫症量表，以及患者自身对 TS 对社会融合影响的 10 分视觉模拟量表）。
Gilles de la Tourette 综合征是一种复杂的神经精神障碍，在普通人群中有较高的发病率。超过 50%的 Gilles de la Tourette 综合征患者存在行为共病，焦虑和抑郁在不同程度上与这种“时好时坏”的临床表现相关。在我们的经验中，DBS 对那些对保守治疗无反应的患者是一种有效的治疗方法。然而，仍需要一个多学科团队来妥善处理这种复杂的治疗选择。
