Testini Paola, Zhao Cong Z, Stead Matt, Duffy Penelope S, Klassen Bryan T, Lee Kendall H
Department of Neurologic Surgery, Mayo Clinic, Rochester, MN.
Department of Medicine, University of California San Francisco, Fresno, CA.
Mayo Clin Proc. 2016 Feb;91(2):218-25. doi: 10.1016/j.mayocp.2015.11.016.
Deep brain stimulation (DBS) of the thalamic centromedian/parafascicular (CM-Pf) complex has been reported as a promising treatment for patients with severe, treatment-resistant Tourette syndrome (TS). In this study, safety and clinical outcomes of bilateral thalamic CM-Pf DBS were reviewed in a series of 12 consecutive patients with medically refractory TS, 11 of whom met the criteria of postsurgical follow-up at our institution for at least 2 months. Five patients were followed for a year or longer. Consistent with many patients with TS, all patients had psychiatric comorbidities. Tic severity and frequency were measured by using the Yale Global Tic Severity Scale (YGTSS) over time (average, 26 months) in 10 subjects. One patient was tested at 2-week follow-up only and thus was excluded from group YGTSS analysis. Final YGTSS scores differed significantly from the preoperative baseline score. The average (n=10) improvement relative to baseline in the total score was 54% (95% CI, 37-70); average improvement relative to baseline in the YGTSS Motor tic, Phonic tic, and Impairment subtests was 46% (95% CI, 34-64), 52% (95% CI, 34-72), and 59% (95% CI, 39-78), respectively. There were no intraoperative complications. After surgery, 1 subject underwent wound revision because of a scalp erosion and wound infection; the implanted DBS system was successfully salvaged with surgical revision and combined antibiotic therapy. Stimulation-induced adverse effects did not prevent the use of the DBS system, although 1 subject is undergoing a trial period with the stimulator off. This surgical series adds to the literature on CM-Pf DBS and supports its use as an effective and safe therapeutic option for severe refractory TS.
据报道，丘脑中央中核/束旁核（CM-Pf）复合体的深部脑刺激（DBS）是治疗重度、难治性抽动秽语综合征（TS）患者的一种有前景的治疗方法。在本研究中，我们回顾了连续12例药物难治性TS患者接受双侧丘脑CM-Pf DBS的安全性和临床结果，其中11例符合我院术后至少随访2个月的标准。5例患者随访了1年或更长时间。与许多TS患者一样，所有患者都有精神科合并症。10名受试者使用耶鲁全球抽动严重程度量表（YGTSS）随时间（平均26个月）测量抽动严重程度和频率。1例患者仅在2周随访时进行了测试，因此被排除在YGTSS组分析之外。最终YGTSS评分与术前基线评分有显著差异。相对于基线，总分的平均（n=10）改善率为54%（95%CI，37-70）；YGTSS运动性抽动、发声性抽动和损害子测试相对于基线的平均改善率分别为46%（95%CI，34-64）、52%（95%CI，34-72）和59%（95%CI，39-78）。术中无并发症。术后，1例受试者因头皮糜烂和伤口感染接受了伤口修复；植入的DBS系统通过手术修复和联合抗生素治疗成功挽救。刺激引起的不良反应并未妨碍DBS系统的使用，尽管1例受试者正在进行关闭刺激器的试验期。这个手术系列增加了关于CM-Pf DBS的文献，并支持其作为重度难治性TS的有效和安全治疗选择的应用。
