Department of Neurology, Medical University of Warsaw, Banacha 1a, 02-091, Warsaw, Poland.
Department of Bioethics, Medical University of Warsaw, Banacha 1a, 02-091, Warsaw, Poland.
Eur Child Adolesc Psychiatry. 2022 Mar;31(3):443-461. doi: 10.1007/s00787-021-01881-9. Epub 2021 Oct 4.
In 2011 the European Society for the Study of Tourette Syndrome (ESSTS) published its first European clinical guidelines for the treatment of Tourette Syndrome (TS) with part IV on deep brain stimulation (DBS). Here, we present a revised version of these guidelines with updated recommendations based on the current literature covering the last decade as well as a survey among ESSTS experts. Currently, data from the International Tourette DBS Registry and Database, two meta-analyses, and eight randomized controlled trials (RCTs) are available. Interpretation of outcomes is limited by small sample sizes and short follow-up periods. Compared to open uncontrolled case studies, RCTs report less favorable outcomes with conflicting results. This could be related to several different aspects including methodological issues, but also substantial placebo effects. These guidelines, therefore, not only present currently available data from open and controlled studies, but also include expert knowledge. Although the overall database has increased in size since 2011, definite conclusions regarding the efficacy and tolerability of DBS in TS are still open to debate. Therefore, we continue to consider DBS for TS as an experimental treatment that should be used only in carefully selected, severely affected and otherwise treatment-resistant patients.
2011 年，欧洲妥瑞氏症研究学会（ESSTS）发表了第一份关于妥瑞氏症（TS）治疗的欧洲临床指南，其中第四部分是关于深部脑刺激（DBS）的。在这里，我们根据过去十年的现有文献以及 ESSTS 专家的调查，呈现了这些指南的修订版，并更新了建议。目前，国际妥瑞氏症 DBS 登记处和数据库、两项荟萃分析和八项随机对照试验（RCT）提供了数据。结果的解释受到小样本量和短期随访期的限制。与开放非对照病例研究相比，RCT 报告的结果不太有利，且结果相互矛盾。这可能与几个不同的方面有关，包括方法学问题，但也可能与显著的安慰剂效应有关。因此，这些指南不仅呈现了来自开放和对照研究的现有数据，还纳入了专家知识。尽管自 2011 年以来，整体数据库的规模有所增加，但 DBS 在 TS 中的疗效和耐受性的明确结论仍存在争议。因此，我们仍将 DBS 治疗 TS 视为一种实验性治疗，仅应在经过精心挑选、严重受影响且其他治疗方法无效的患者中使用。
