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深部脑刺激治疗妥瑞氏症。

Deep brain stimulation for Tourette's syndrome.

机构信息

School of Medicine, Koc University, Istanbul, Turkey.

Department of Neurosurgery, Korle Bu Teaching Hospital, Accra, Ghana.

出版信息

Neurosurg Rev. 2024 Oct 5;47(1):734. doi: 10.1007/s10143-024-02958-0.

Abstract

Tourette's syndrome is a neuropsychiatric disorder characterized by formidable motor and vocal tics. Many individuals also present with comorbid neuropsychiatric conditions. Though patients often benefit from pharmacological and behavioral therapies, a subset of individuals develop severe, treatment-resistant symptoms that might necessitate more invasive interventions, such as Deep Brain Stimulation (DBS). DBS, particularly targeting regions like the globus pallidus internus (GPi) and the centromedian-parafascicular complex (CM-Pf) of the thalamus, has demonstrated effectiveness in reducing tic severity and improving quality of life. This review outlines the mechanism, clinical efficacy, and long-term outcome of DBS in TS. Results from clinical studies reveal significant reductions in tics. However, success with DBS is variable depending on a number of factors, including target selection and electrode placement. The use of DBS has ethical considerations, which include risks to the surgical procedure, the need for full and complete informed consent, and questions about the implications of such treatment on cognitive and emotional growth. Long-term follow-up will be required to ensure appropriate patient outcomes and complication management. Additional research and ethical debate will be needed with advancing DBS technology to ensure responsible and equitable treatment. This paper narratively summarizes the surgical options available for TS, with a focus on the current status of DBS in the management of the disease.

摘要

妥瑞氏症候群是一种神经精神疾病,其特征为严重的运动性和发声性抽搐。许多患者还同时存在其他神经精神疾病。尽管患者通常受益于药物和行为疗法,但有一部分人会出现严重、治疗抵抗的症状,可能需要更具侵入性的干预,如深部脑刺激(DBS)。DBS 特别是针对丘脑的苍白球 internus(GPi)和中央中缝核-旁正中复合体(CM-Pf)等区域,已被证明能有效减轻抽搐严重程度和改善生活质量。本综述概述了 DBS 在妥瑞氏症中的作用机制、临床疗效和长期结果。临床研究结果显示,抽搐明显减少。然而,DBS 的成功与否取决于多个因素,包括目标选择和电极放置。DBS 的使用存在伦理问题,包括手术风险、充分和完整的知情同意的需要,以及关于这种治疗对认知和情感成长的影响的问题。需要进行长期随访以确保患者获得适当的结果和管理并发症。随着 DBS 技术的不断进步,需要进行更多的研究和伦理辩论,以确保这种治疗的合理性和公平性。本文通过叙述性总结了妥瑞氏症的手术选择,重点介绍了 DBS 在该疾病管理中的现状。

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