深部脑刺激治疗比保守措施更能显著改善抽动秽语综合征的症状：一项荟萃分析。
Deep Brain Stimulation Results in Greater Symptomatic Improvement in Tourette Syndrome than Conservative Measures: A Meta-Analysis.
机构信息
Case Western Reserve University, Cleveland, Ohio, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
出版信息
Stereotact Funct Neurosurg. 2020;98(4):270-277. doi: 10.1159/000507059. Epub 2020 May 20.
INTRODUCTION
Deep brain stimulation (DBS) has emerged as a safe and effective therapy for refractory Tourette syndrome (TS). Recent studies have identified several neural targets as effective in reducing TS symptoms with DBS, but, to our knowledge, none has compared the effectiveness of DBS with conservative therapy.
METHODS
A literature review was performed to identify studies investigating adult patient outcomes reported as Yale Global Tic Severity Scale (YGTSS) scores after DBS surgery, pharmacotherapy, and psychotherapy. Data were pooled using a random-effects model of inverse variance-weighted meta-analysis (n = 168 for DBS, n = 131 for medications, and n = 154 for behavioral therapy).
RESULTS
DBS resulted in a significantly greater reduction in YGTSS total score (49.9 ± 17.5%) than pharmacotherapy (22.5 ± 15.2%, p = 0.001) or psychotherapy (20.0 ± 11.3%, p < 0.001), with a complication (adverse effect) rate of 0.15/case, 1.13/case, and 0.60/case, respectively.
CONCLUSION
Our data suggest that adult patients with refractory TS undergoing DBS experience greater symptomatic improvement with surprisingly low morbidity than can be obtained with pharmacotherapy or psychotherapy.
简介
深部脑刺激（DBS）已成为治疗难治性妥瑞氏综合征（TS）的一种安全有效的疗法。最近的研究已经确定了几个有效的神经靶点，通过 DBS 可以减轻 TS 症状，但据我们所知，没有研究比较过 DBS 与保守治疗的效果。
方法
我们进行了文献回顾，以确定研究成人患者结果的报告，这些研究使用耶鲁总体抽搐严重程度量表（YGTSS）评分，比较 DBS 手术后、药物治疗和心理治疗后的结果。使用逆方差加权荟萃分析的随机效应模型对数据进行汇总（DBS 组 n = 168，药物组 n = 131，行为治疗组 n = 154）。
结果
DBS 治疗后 YGTSS 总分的降幅明显大于药物治疗（49.9% ± 17.5% vs. 22.5% ± 15.2%，p = 0.001）或心理治疗（20.0% ± 11.3%，p < 0.001），并发症（不良事件）发生率分别为 0.15/例、1.13/例和 0.60/例。
结论
我们的数据表明，接受 DBS 治疗的难治性 TS 成年患者的症状改善程度明显大于药物治疗或心理治疗，且发病率较低。
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