Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Neurosurgery, Shanghai Children's Medical Center, Affiliated to the Medical School of Shanghai Jiao Tong University, Shanghai, China.
J Neurol. 2022 Nov;269(11):6116-6126. doi: 10.1007/s00415-022-11266-w. Epub 2022 Jul 21.
Deep brain stimulation (DBS) is a promising novel approach for managing refractory Gilles de la Tourette's syndrome (GTS). The subthalamic nucleus (STN) is the most common DBS target for treating movement disorders, and smaller case studies have reported the efficacy of bilateral STN-DBS treatment for relieving tic symptoms. However, management of GTS and treatment mechanism of STN-DBS in GTS remain to be elucidated.
Ten patients undergoing STN-DBS were included. Tics severity was evaluated using the Yale Global Tic Severity Scale. The severities of comorbid psychiatric symptoms of obsessive-compulsive behavior (OCB), attention-deficit/hyperactivity disorder, anxiety, and depression; social and occupational functioning; and quality of life were assessed. Volumes of tissue activated were used as seed points for functional connectivity analysis performed using a control dataset.
The overall tics severity significantly reduced, with 62.9% ± 26.2% and 58.8% ± 27.2% improvements at the 6- and 12-months follow-up, respectively. All three patients with comorbid OCB showed improvement in their OCB symptoms at both the follow-ups. STN-DBS treatment was reasonably well tolerated by the patients with GTS. The most commonly reported side effect was light dysarthria. The stimulation effect of STN-DBS might regulate these symptoms through functional connectivity with the thalamus, pallidum, substantia nigra pars reticulata, putamen, insula, and anterior cingulate cortices.
STN-DBS was associated with symptomatic improvement in severe and refractory GTS without significant adverse events. The STN is a promising DBS target by stimulating both sensorimotor and limbic subregions, and specific brain area doses affect treatment outcomes.
深部脑刺激（DBS）是一种治疗难治性 Gilles de la Tourette 综合征（GTS）的有前途的新方法。丘脑底核（STN）是治疗运动障碍最常用的 DBS 靶点，较小的病例研究报告了双侧 STN-DBS 治疗缓解抽动症状的疗效。然而，GTS 的管理和 GTS 中 STN-DBS 的治疗机制仍有待阐明。
纳入 10 例接受 STN-DBS 的患者。使用耶鲁整体抽动严重程度量表（Yale Global Tic Severity Scale）评估抽动严重程度。评估共病强迫症行为（OCB）、注意力缺陷/多动障碍、焦虑和抑郁的精神症状严重程度、社会和职业功能以及生活质量。使用组织激活体积作为种子点，使用对照组数据集进行功能连接分析。
总体抽动严重程度显著降低，分别在 6 个月和 12 个月随访时改善 62.9%±26.2%和 58.8%±27.2%。所有 3 例共病 OCB 的患者在两次随访中均改善了 OCB 症状。GTS 患者对 STN-DBS 治疗的耐受性较好。最常见的不良反应是轻度构音障碍。STN-DBS 的刺激作用可能通过与丘脑、苍白球、黑质网状部、壳核、岛叶和前扣带回皮质的功能连接来调节这些症状。
STN-DBS 与严重和难治性 GTS 的症状改善相关，无明显不良事件。STN 是一种有前途的 DBS 靶点，通过刺激感觉运动和边缘亚区，特定脑区剂量影响治疗效果。
