Department of Neurosurgery, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Department of Psychiatry, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
Neurol Med Chir (Tokyo). 2021 Jan 15;61(1):33-39. doi: 10.2176/nmc.oa.2020-0202. Epub 2020 Nov 26.
The efficacy of deep brain stimulation (DBS) for refractory Tourette syndrome (TS) is accepted, but whether the efficacy of DBS treatment in the Japanese population is equivalent to those reported internationally and whether adverse effects are comparable are not yet known. This study evaluated the clinical practice and outcome of DBS for TS in a Japanese institution. This study included 25 consecutive patients with refractory TS treated with thalamic centromedian-parafascicular nucleus DBS. The severity of tics was evaluated with the Yale Global Tic Severity Scale (YGTSS) before surgery, at 1 year after surgery, and at the last follow-up of 3 years or more after surgery. The occurrence of adverse events, active contact locations, and stimulation conditions were also evaluated. YGTSS tic severity score decreased by average 45.2% at 1 year, and by 56.6% at the last follow-up. The reduction was significant for all aspects of the scores including motor tics, phonic tics, and impairment. The mean coordinates of active contacts were 7.62 mm lateral to the midline, 3.28 mm posterior to the midcommissural point, and 3.41 mm above anterior commissure-posterior commissure plane. Efficacy and stimulation conditions were equivalent to international reports. The stimulation-induced side effects included dysarthria (32.0%) and paresthesia (12.0%). Device infection occurred in three patients (12.0%) as a surgical complication. The DBS device was removed because of infection in two patients. DBS is an effective treatment for refractory TS, although careful indication is necessary because of the surgical risks and unknown long-term outcome.
深部脑刺激（DBS）治疗难治性妥瑞氏综合征（TS）的疗效已被认可，但 DBS 治疗在日本人群中的疗效是否与国际报道相当，以及不良反应是否可比，目前尚不清楚。本研究评估了日本某机构 DBS 治疗 TS 的临床实践和结果。本研究纳入了 25 例接受丘脑中央中脑旁核 DBS 治疗的难治性 TS 连续患者。手术前、手术后 1 年和手术后 3 年以上的最后一次随访时，使用耶鲁整体 Tic 严重程度量表（YGTSS）评估 tic 的严重程度。还评估了不良事件的发生、主动接触部位和刺激条件。YGTSS tic 严重程度评分在 1 年时平均下降 45.2%，在最后一次随访时下降 56.6%。所有评分方面的 tic 严重程度，包括运动 tic、语音 tic 和障碍，均有显著下降。主动接触部位的平均坐标为中线外侧 7.62mm，中脑连合点后 3.28mm，前连合-后连合平面上 3.41mm。疗效和刺激条件与国际报道相当。刺激引起的副作用包括构音障碍（32.0%）和感觉异常（12.0%）。3 例患者（12.0%）发生手术并发症导致设备感染。由于感染，2 名患者的 DBS 设备被移除。DBS 是治疗难治性 TS 的有效方法，但由于手术风险和未知的长期结果，需要谨慎选择适应证。
