Visser-Vandewalle V, Kuhn J
Department of Neurosurgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Handb Clin Neurol. 2013;116:251-8. doi: 10.1016/B978-0-444-53497-2.00020-6.
Tourette syndrome is a neuropsychiatric disorder characterized by motor and vocal tics, often associated with behavioral disorders, with typical onset in early childhood. In most patients, the symptoms decrease spontaneously when adulthood is reached, or can be treated with behavioral therapy or medication. Only a small proportion of patients are candidates for surgical treatment. In 1999, thalamic deep brain stimulation (DBS) was introduced for intractable Tourette syndrome. Since then, a diversity of targets have been used, located mainly at the level of the medial part of the thalamus, in the globus pallidus internus (anteromedial limbic and posteroventrolateral motor part), the globus pallidus externus, and the internal capsule/nucleus accumbens. The pathophysiology of Tourette syndrome is still a matter of considerable debate. Current knowledge of cortical-basal ganglia-thalamocortical circuits provides explanations for the beneficial effects of DBS on tics. Inclusion and exclusion criteria have been formulated to identify good candidates for DBS. Because of the small number of patients, there is a strong need for multicenter double-blind trials with standard protocols.
抽动秽语综合征是一种神经精神疾病，其特征为运动性和发声性抽动，常伴有行为障碍，典型发病于儿童早期。在大多数患者中，症状在成年后会自行减轻，或者可以通过行为疗法或药物治疗。只有一小部分患者适合手术治疗。1999年，丘脑深部脑刺激术（DBS）被用于治疗难治性抽动秽语综合征。从那时起，人们使用了多种靶点，主要位于丘脑内侧部分、苍白球内侧部（前内侧边缘和后腹外侧运动部分）、苍白球外侧部以及内囊/伏隔核水平。抽动秽语综合征的病理生理学仍然是一个备受争议的问题。目前对皮质-基底神经节-丘脑皮质回路的认识为DBS对抽动的有益作用提供了解释。已经制定了纳入和排除标准以确定DBS的合适候选者。由于患者数量较少，非常需要采用标准方案的多中心双盲试验。
