Servello Domenico, Zekaj Edvin, Saleh Christian, Lange Nicholas, Porta Mauro
*Departments of Neurosurgery and Neurology, IRCCS Galeazzi, Milan, Italy;‡Department of Psychiatry, Harvard Medical School, Neurostatistics Laboratory, Belmont, Massachusetts.
Neurosurgery. 2016 Jan;78(1):91-100. doi: 10.1227/NEU.0000000000001004.
Gilles de la Tourette syndrome (GTS) is a severe neuropsychiatric disorder with childhood onset, characterized by disabling motor and vocal tics lasting for more than 1 year and associated with a wide range of psychiatric comorbidities. Pharmacological treatment is indicated for moderate to severe GTS patients. However, when GTS is refractory to conventional medical and behavioral treatments, deep brain stimulation (DBS) can be considered as a last resort therapeutic avenue.
To evaluate the efficacy of DBS and its comorbidities in the largest pool of GTS patients to date.
Our cohort study was based on 48 patients' refractory to conventional treatment who underwent DBS for GTS at Galeazzi Institute, Milan, Italy. An exhaustive preoperative and a follow-up battery of tests was performed including the Yale Global Tic Severity Rating Scale, the Yale-Brown Obsessive Compulsive Scale, the Beck Depression Inventory, the State Trait Anxiety Inventory, and the Subjective Social Impairment on a 10-point Visual Analogue Scale tests.
Eleven patients in whom the device was removed for inflammatory complications or for poor compliance were excluded from final analysis. Twenty-seven of the remaining 37 patients had a Yale Global Tic Severity Rating Scale score at the last follow-up that was less than 35. Of the 37 patients, in 29 cases (78%) a reduction of more than 50% of the Yale Global Tic Severity Rating Scale score was observed.
The clinical efficacy of DBS in GTS is promising. Although DBS is associated with risks, as is any surgical intervention, DBS should be considered as a last resort therapeutic option in carefully selected GTS patients.
抽动秽语综合征（GTS）是一种儿童期起病的严重神经精神障碍，其特征为致残性运动和发声抽动持续超过1年，并伴有多种精神共病。中重度GTS患者需进行药物治疗。然而，当GTS对传统药物和行为治疗无效时，可考虑将脑深部电刺激（DBS）作为最后的治疗手段。
评估DBS在迄今为止最大规模的GTS患者群体中的疗效及其共病情况。
我们的队列研究基于48例对传统治疗无效的患者，这些患者在意大利米兰的加莱阿齐研究所接受了针对GTS的DBS治疗。进行了详尽的术前和随访一系列测试，包括耶鲁全球抽动严重程度评分量表、耶鲁-布朗强迫量表、贝克抑郁量表、状态-特质焦虑量表以及10分视觉模拟量表主观社会功能损害测试。
11例因炎症并发症或依从性差而取出装置的患者被排除在最终分析之外。其余37例患者中，27例在最后一次随访时耶鲁全球抽动严重程度评分量表得分低于35。在这37例患者中，29例（78%）耶鲁全球抽动严重程度评分量表得分降低超过50%。
DBS治疗GTS的临床疗效前景良好。尽管与任何手术干预一样，DBS存在风险，但在经过精心挑选的GTS患者中，DBS应被视为最后的治疗选择。
