Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Germany.
Clinic of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Germany; Department of Neurology, Medical University of Warsaw, Poland; Department of Neurology, Yale School of Medicine, New Haven, USA; Department of Bioethics, Medical University of Warsaw, Warsaw, Poland.
Brain Stimul. 2021 May-Jun;14(3):662-675. doi: 10.1016/j.brs.2021.04.004. Epub 2021 Apr 18.
There are still no sufficient data regarding the use of deep brain stimulation (DBS) in Gilles de la Tourette syndrome (GTS) and no agreement on optimal target.
To compare efficacy and safety of bilateral DBS of thalamus (centromedian-ventro-oral internus, CM-Voi) versus posteroventral lateral globus pallidus internus (pvl GPi)) versus sham stimulation, and baseline in severe medically refractory GTS.
In this randomized double-blind sham stimulation-controlled trial (RCT), 10 patients (3 women, mean age = 29.4 ± 10.2 SD, range 18-47) underwent three blinded periods each lasting three months including (i) sham, (ii) pvl GPi (on-GPi), and (iii) thalamic stimulation (on-thal) followed by an open uncontrolled long-term follow-up (up to 9 years) with individually determined target and stimulation settings.
Nine patients completed the RCT. At group level, on-GPi - but not on-thal - resulted in a significant tic reduction compared to baseline, but had no effect on premonitory urges and psychiatric comorbidities. Direct comparisons of targets resulted in inconsistent or negative (compared to sham) findings. During follow-up, we found no improvement of tics, comorbidities, and quality of life at group level, however, single patients benefitted continuously from thalamic DBS. At last follow-up 89.9 months (mean) after surgery, 50% of patients had discontinued DBS. Hardware infections occurred in 3/10 patients.
Our data suggest that the initial effect of pvl GPi DBS is superior to thalamic (CM-Voi) DBS. While half of the patients discontinued treatment, single patients benefitted from thalamic DBS even after years. It is likely that outcome is influenced by various factors beyond the mere change in tic severity.
目前针对使用深部脑刺激（DBS）治疗抽动秽语综合征（GTS）仍缺乏足够的数据，也没有关于最佳靶点的共识。
比较丘脑（中央中脑腹侧核-口内）双侧 DBS 与后外侧苍白球 internus（pvl GPi）双侧 DBS 与假刺激，以及严重药物难治性 GTS 的基线疗效和安全性。
在这项随机、双盲、假刺激对照试验（RCT）中，10 名患者（3 名女性，平均年龄 29.4 ± 10.2 岁，范围 18-47 岁）接受了三个为期三个月的盲法期，包括（i）假刺激，（ii）pvl GPi（on-GPi）和（iii）丘脑刺激（on-thal），随后进行个体化目标和刺激设置的开放非对照长期随访（最长 9 年）。
9 名患者完成了 RCT。在组水平上，on-GPi - 但不是 on-thal - 与基线相比导致 tic 显著减少，但对预感冲动和精神共病没有影响。目标的直接比较导致不一致或负面（与假刺激相比）的结果。在随访期间，我们没有发现 tic、共病和生活质量在组水平上的改善，然而，个别患者持续受益于丘脑 DBS。在最后一次随访（术后 89.9 个月）时，50%的患者已经停止了 DBS。10 名患者中有 3 名发生了硬件感染。
我们的数据表明，pvl GPi DBS 的初始效果优于丘脑（CM-Voi）DBS。虽然有一半的患者停止了治疗，但个别患者甚至在多年后仍受益于丘脑 DBS。结果可能受到除 tic 严重程度变化之外的各种因素的影响。
